Journal of Family Therapy (1981) 3 : 113-138

‘Can I (let you let me) leave?’

Therapy with the adolescent and his family
Hugh Jenkins”

A number of dimensions are reviewed in relation to adolescence. The

focus is primarily on adolescence in the context of the family, but it is
acknowledged that this is an arbitrary and restricted view of wider
social and cultural contexts. It is briefly suggested why this area of
work may have been under-represented in professional work in the
past. An outline is given of varying ways of defining adolescence, and
the impact of this developmental stage in the family life cycle for the
adolescent and his family. Within this context, choices must be made
over approaches to treatment, and a structural hierarchical framework
is proposed.Some of thesedilemmas are discussed in relation to
therapy with afamily where the presenting problem was drug addiction
in the younger son. This case was chosen for the many difficulties it
raised for the therapist and the other professionals directly involved.
The subsequent discussion looks at the implications of some of the
mistakes made in therapeutic strategy.

Introduction
T h e Vine family responded to a newspaper advertisement and agreed to
take part in a video taped family interview to find out how families ‘tick’.
They had no previous contact with any of the psychological helping pro-
fessions. T h e family consisted of the parents and six children, ranging in
age from eighteen to seven years. T h e eldest, Adrian, and the third eldest,
Paula, did not come. T h e transcript is taken from the early part of the
interview, as theparents talk abouttheirexperiences of bringing up
children.
Th. What happens dad, because I mean the . . . we know that in families that
mums often (to MO.)
are you working?
MO. No.. ..
Th. . . . then particularly are at home and involved with the bringing up of the
kids. What happens, or particularly used to happen when all the children

* The Young People’s Unit, Velindre Road, Whitchurch, Cardiff, CF4 7JG.
113
0163-4445/81/020113+26 $02.00/0 01981 The Association for Family Therapy
114 H . Jenkins
were younger when mother had had a hard day, had done everything she
could and somehow the kids just wouldn’t play ball? What would happen
when you came home from work?
Fa. Well, sometimes I, well, I had to take over.
Th. Hmm. Howwould thathappen? Whatwouldhappenwhenyougot
home?
Fa. Not often. . . .
MO. No, you never had that kind of thing did you? I think (to Th.) what you
mean is, in relation, did he ever come home and I was tearing my hair
out, you know. . . .
Th. Most mums do at some stage. . . .
MO. No never when they were small. Now with the teenagers sometimes I feel
like doing that, but of course we’re both there, so it . . . I suppose it’s not
quite as bad, you know. . . .
Th. So, in some ways it’s easier when the children are smaller.
MO. Much easier when they’re smaller than when they become teens. I know
you have to do every . . . everything for them, but at least there comes a
time whenyoucansay, ‘Oh goodgracious,they’vegone to bed,’ you
know, ‘I can flop in this chair and forgetall about it now until the morning.’
But at least when they’re teenagers you got them up . . . you can’t say to a
14-year-old at nine o’clock,‘Look, come on goto bed’, I mean, you know,
you can at least, you can say ‘Oh go to your room, I’ve had enough; I’m
not going to tolerate you arguing’ you know, ‘I can’t stand it any more.’
But it was much easier when they were smaller, wasn’t it?
Fa. Yes. . . .
MO. Because you worked shifts, and when you came home. . . .
Fa. (Simultaneously) I worked shifts. . . .
MO. When you came home, I mean, they were in bed, weren’t they? We had
time to sit down, and we had time to have a talk. We don’t have those
times now, do we?
Fa. No, no. . . .
It is clear from this transcript that mother is pivotal in the family’s com-
municationpattern.Issuesaboutwhodoesthemotheringarecentral
throughout the session, and there is a sense in which this is under threat
as the children grow older. They report, largely through mother, that the
issues or difficulties encountered in bringing up children are mapped along
a dependency-autonomy continuum.T h e impression is gained that mother
feels more competent, perhaps moreof a mother, with young children, and
that the transition to adolescence holds particular stresses for her. Perhaps
it is significant that the two absent members were those whom mother
described elsewhere variously as ‘difficult’, and in the case of Adrian, as
‘like an alien almost’. T h e stresses experienced around adolescent develop-
ment are furthercrystallized in the second extract:
 ‘Can I leave?’ 115
Th. So I’m beginning to understand in fact that as kids, you know, . . . from
what you are saying, that as kids get older, in fact, the whole thing about
who’s running this show becomes, uhh, . . . .
MO. Well, like sometimes it’s likea . . . it’s almost a battle of wills, you know. . . .
Th. Or that perhapsas particularly children become teenagers and at 18 are
young men or young women, . . . .
MO. I don’t know, I don’t think it affects all. I think you can almost spot who
it’s going to affect. I had a feeling it would affect Adrian, I had a feeling
it would affect Paula, because she’s so much like Adrian. . . .

T h e two who in this family have made distinct bids to be different, are
identified in the session as outside the family group norms.
This paperconsiderssome of theproblem areasfrequentlymetin
families with adolescent members. It identifies in particular some of the
characteristics of a therapeuticstylewhich pays attentiontostructure
(Minuchin, 1974) and hierarchy (Haley, 1976, 1980). Such a style may be
used to deal with a wide range of presenting problem. Implicit in this is
an understanding of process common to a broad spectrum of therapeutic
style which is not the exclusive preserve of any single school of therapy
(BandlerandGrinder,1975;GrinderandBandler,1976; Haley, 1963;
Scheflen, 1972; Watzlawick, 1978). The main focus here is the adolescent
and his family. However, the wider social, cultural, and economic contexts
should not be ignored in treatment. ‘The family as a behaviour system
standsintermediatebetweentheindividualandculture. It transmits
through its adolescent members the disorders that characterize the social
system’ (Ackerman, 1970). This emphasizes the more diffuse relationship
between the adolescent, his family, and the wider context, as well as the
immediate nuclear familial setting. Just as the disturbing behaviour of an
adolescentmaybefunctionalinthecontext of hisfamily, so familial
disturbance may be functional in a wider social context. T o assume that
one causes, or is caused by, the other, is less useful than to view each level
as part of a series of interdependent interacting systems.

Service provisions
T h e treatment of adolescents in psychiatry falls between the well-defined
areas of child guidance and the traditional mainstream of adult psychiatry,
the latter tending to be sited in large psychiatric hospitals. Social service
and probation departments have clear areas of workbased on types of
presenting problem and on age. T h e 1969 Children and Young Persons
Act transferred the responsibility for younger adolescents from probation
to social service departments, while probation concentrate more on adult
116 H . Jenkins
and marital work. However, the between age presents organizations and
practitionerswithproblemsabouttreatmentandmanagement.When
organizations are faced with the problem of residential care for disturbed,
delinquent, or 'sick' adolescents, the dilemma is frequently whether she/he
should be placed in a setting designed for children or adults. Psychiatric
hospitals prefer not to take people under the age of eighteen, and social
service departments frequently lack a comprehensive range of resources
for young people over the age of sixteen. Adolescent units are one response
to the dilemmas posed society by problems in adolescence.

Defining adolescence
Difficultiesexistwhicharepeculiartotheperiodbroadlydescribed as
adolescence. T h e successfulnegotiation of thisstage is essential to the
integration and development of the individual and his family members.
'Althoughtheunderstanding of adolescentbehaviour is crucialtothe
entire theoryof personality maturation, some aspects of the problem remain
to thisday a mystery. Adolescent behaviour is ever-changing. It is unstable,
elusive, and evanescent; its true meaning occasionallyescapeseven the
Extenston of further educatlon
prolongsreliance on familylstate.
l
18+
Legal adult; can vote, marry;
responsible for own debts.
'18
Can join army - die for country
17 '4
Can leave school; canmarry,,with
adult consent (1.e bean 'odult
subject to adultpermission); age
ofhetero-sexual consent.
'l6
Pubescence: physiological changes, and
increased physical awareness of self and others
11/12

0 10 20 30
blrth
infancy
childhood .... ' 21
Former point of legal
adulthood, now lowered
to 18.
Young odult

Figure 1.
 ‘Can I leave?’ 117
most astute observer’ (Ackerman, 1958). Yet cultural and legal definitions
are not absolute, and sometimes confusing (Figure 1).
T h e schematic representation proposed in Figure 1 is deceptively clear,
since none of these points are immutable. Children reach puberty earlier
than did their parents. At the same time, the individual is defined as de-
pendent on his parents for a longer period by law due to the raisingof the
age of compulsory school attendance in the U.K. from fifteen to sixteen
years. At sixteen, consenting heterosexual relations are legally sanctioned,
but permission to formalize them through marriage must still be sought
from a parent or guardian until the age of eighteen. Although the age
until which a person should receive full-time education has been raised,
the age of majority has been lowered from twenty-one to eighteen. This
has taken place in the context of a society which continues to be tech-
nologically more complex, and so requires many of its members to train
for longer periods of time in order adequately to service its needs. In order
to complete apprenticeships orprofessional training, young people may be
forced to remain dependent on their families or the state until their early
or mid-twenties. T h e final physiological, social, emotional, and economic
coming together may well be spread over a span of some ten or twelve
years. This process of dependence may even be extended and intensified
in times of economic recession due to unemployment, as happened in the
United States during the Great Depression of the inter-war years. When
society is unclear at what point an individual finally becomes fully adult,
there being no universally recognized rites de passage to mark such a time,
it is scarcely surprising that the normal turmoilof maturation and identity
formationshouldbeexacerbated as much for the family as forthe
individual.

Main developmental issues

Changesin familyorganizationalstructureare necessary inorderto
accommodate the physical entries and exits of its members, such as the
marriage of a grown-up child, the birth of a baby, or death of a family
member. T h e onset of different life stages will affect the family. For
example, when a child first goes toschool, enters adolescence, moves from
youngadulttomiddle age. ‘The tasksfacingfamily membersateach
stagearenotadditive.Thesequalitativelydifferentstagesdemanda
reorganization of the whole family system, although not all members need
be affected equally by this reorganization’ (Ritterman, 1977).T h e physical
or emotional changes that takeplace in moving through stages involve
costs as well as gains (Erikson, 1950).
 Adolescence marks the transition from childhood to adulthood. During
this time the individual experiences changes associated with physical and
sexualdevelopment,coupledwith familial andculturalpressures.This
period is one of steps forward and backward: ‘Fear of being a child pushes
the adolescentforward.Fear of being an adultpusheshim backward’
(Ackerman, 1958). T h e adolescent demands and receives new privileges,
but he also is expected to accept new responsibilities. T o the adult world,
his responses frequently appear irrational and unpredictable. It is as if
she/he simultaneously communicates: ‘Let me go’ and, ‘Don’t ditch me’.
T h e ways in which the important adults in anadolescent’s life respond to
these conflicting, but not mutually exclusive messages, will greatly affect
the success or failureof the transition forall concerned. Whereas there are
processes of adjustment which are primarily individual in termsof altered
physique, stronger sexual feelings and the physical ability to carry these
through, together with a heightened sensitivity towards one’s own self-
image, there are other areasof crucial importance for interpersonal adjust-
ment to take place. T h e adolescent’s experience of his family’s ability to
treat him differently will affect his ability to deal differently and appro-
priately with a widersocial context. Each systemlevel of individual, family,
andwider social network,isbutoneaspect of atotalinter-connected
process.
Parents may experience anxiety in dealing with the unpredictable and
confusing behaviour of their adolescent members. A traditional psycho-
dynamic formulation of the process proposes :
The transformation of personal identity and the relation of this to parental and
family identity is a critically important phenomenoninadolescence.Oedipal
conflict of every shade is prominent in adolescence. The patterns of relationship
to the parents which prevailed at the age of five or six years are reactivated. The
emotional tendencies inherent in these relationships are affected, however, by
overt sexual pressures and the increased maturity of the adolescent. (Ackerman,
1958).

Development clearly involves more than the individual. It encompasses

family and peer groups. ‘As the child moves forward on the developmental
scale, each step demands the giving up of former positions and gains, not
only from the childhimself but also from the parent’ (Shapiro, 1967). This
echoes the earlier work of Erikson: ‘The strength acquired atany stage is
tested by the necessity to transcend it in such a way that the individual
can take chances with what was most vulnerably precious in the previous
one’ (1950). This will be doubly difficult for the adolescent whose parents
eitherremainunclearaboutdealingwiththeirownphysiologicaland
 ‘Can I leave?’ 1 19
emotional development in relationto their own childhood andadolescence
(Stierlin, 1975) or who are experiencing undue strain in facing current
difficulties related to stages in their ownlife cycle (Pincus and Dare,1978).
Perhaps the particular stage is less important for the development of the
individual and his family than the negotiations about moving from one to
the next (Haley, 1973). Although the therapist should be awareof the
developmental stages of adolescence, the main focus here is on the struc-
tural,hierarchicalaspects of family life, whereadolescentsfrequently
occupy a vulnerable position, balanced between the conflicting pulls of
autonomy and dependency.T h e problems of adolescence are viewed in the
contextwithinwhichtheyoccur,where‘whatisknown as adolescent
turmoil can be seen as a struggle within thefamily system to maintain the
previous hierarchical arrangement’ (Haley, 1973). Frequently those ado-
lescent turmoils coincide with mid-life marital turmoils centred on the
tensions of generativity or stagnation (Erikson, 1950) and of readjustment
associated with the absence of dependent children to represent an explicit
reasonfor the continuation of amarriage.Moreover,the felt needs of
different members may well conflict according to how each transition is
dealt with. Of the developmental changes in family members, one of the
most common ‘. . . is the emergence of a child into adolescence. At that
time the child’s participation in the extra familial world and his status in
that world increase. T h e relationship between child and parents is dis-
located. T h e adolescent should be movedaway from the sibling subsystem
and given increased autonomy and responsibility appropriate to his age’
(Minuchin, 1974). I n order that the individual and his family avoid the
stress associatedwith suchchange,awholerange of dysfunctionalor
symptomatic behaviour may be adopted by the adolescent in his family
(Minuchin et al., 1978).
T h e therapistwhoadoptsastructuralframework,takingaccount of
systemic organizational issues, will focus in treatment on altering these
patterns of interaction which maintain the problem(s). In this case, be-
havioural or psychosomatic difficulties may be viewed as a function of the
difficulties members have in facing the conflicts of individuation. Adolescent
crises may function homeostatically to maintain status the quo of threatened
transactional patterns. If the effects of these become overpowering, they
will seriouslythreatentheability of theadolescentandhis family to
separate while remaining involved with one another. T h e structure of a
family will not be readily apparent, although the family’s use of physical
space,bodyposture, facial expression, will providetheexperienced
therapist with indicationsof what islikely to be(Scheflen, 1972). ‘Structure
is expressed in action ; members define themselves in interaction’ (Ritter-
120 H . Jenkins
man, 1977) and it is important to observe the family system as members
deal with each other.
I n what ways do adolescents typically define themselves in and with
their families when they come to the notice of professional agencies as
being in need of help? Haley (1980) proposes that a common theme is one
of failure :
One can be distracted by the bizarre nature of the behaviour or offencesof
problem young people and overlook the main theme that runs through their
lives-failure. When theyapproach success, they do something that ends it.
Success andfailure will vary withthe definition of a particular family, but success
is generally defined here as behaving competentlyin work or school and success-
fully forming intimate relations outside the family. Essentially success is defined
as being self-supporting and able to form a family of one’s own. It does not
mean that aperson is a failure if he or she does not marry and havechildren, but
it does mean that one should be able to have intimate relations outside one’s
family of origin.
Failure applies equally to the family’s difficulties in launching the young
person onto that next stage of his or her life. Leaving and letting go are
complementary processes. Other family members may just aswell display
bizarre and confusing behaviours which hinder the young person. from
effecting appropriate emotional separation. If the therapist becomes pre-
occupiedwithstrangebehaviour, he will quicklybecomelost inthe
intricaciesandminutiae of meaning,and so fail to offer usefulalter-
natives to the family. H e will become a victim of the unacknowledged
function of the behaviour. Failing behaviour can be seento have two main
functions :
(1) The social function: The young person stabilizes a group of intimates by
his or her eccentric behaviour. It is this function which is the main issue for
therapeutic interventions. (2) The metaphoric function: Every deviant act is also
a message to the members of the group and to outsiders. The act can be seen
as a metaphor, often a parody, of a theme important to the group. Usually it is
a group issue which is conflictual. (Haley, 1980).
This indicatessome of the salientissuesassociatedwithtroubles in
adolescence. T h e therapist’s task is to operationalize his understanding in
such a way as to help those variously involved in those difficulties move
on to the nextstage.

Treatment choices
Whatever views atherapist holds on the meaning of adolescent disturbance,
they will determine his framework for planning treatment. Breunlin and
 ‘Can I leave?’ 121
Breunlin(1979)review theliteratureon afamily therapyapproachto
treating adolescent disturbances, and conclude :
Family Therapy may be viewed as an orientation or as a method. Those who
view it as an orientation hold that all adolescent disturbances are a manifestation
of a dysfunctional family system. As such, family therapy is the treatment of
choice, and even should the therapist elect to see a subsystem or an individual
in the family, the focus would remain on the family system, and the desired
changes in that system. Those who see family therapy as an orientation would be
puzzled by any attempt to define indications and contra-indications of family
therapy because in all cases it is positively indicated. On the other hand, those
whoviewfamilytherapyas a methodwouldattempt to make a differential
assessment of each case, and apply family therapyto those cases where it seemed
indicated.
T h e proposal here is that Family Therapy is an orientation. This should
notbeconfusedwithdifferencesinstyleortechnique(Madanesand
Haley, 1977; Cooklin, 1979). T h e therapeutic framework is based on an
understanding of communication (Watzlawick et al., 1967 ; Watzlawick,
1978) ; on the therapeutic use of resistance (Haley, 1963 ; Erickson and
Rossi, 1975);on the importance of understanding the context within which
the problem is maintained (Watzlawick et al., 1974); and on a cybernetic
understanding of behaviourpatterns(Bateson,1973; Palazzoli et al.,
1978). The main operational baseis to identify family structure (Minuchin,
1974; Minuchin et al., 1978; Kaufman and Kaufmann, 1979), and to pay
particular attention to violations in hierarchy as a manifestation of system
distress(Haley,1967,1976,1980;Madanes, 1980). Such aframework
provides the therapist witha framework within which to’work, and outside
which to step at times, as he struggles with thecomplexities of treatment.
Adolescence posesthe therapist witha particular challenge with its mixture
of rigidity and unformedness. It is also a particularly sensitive period in
any family’s life, since the issue is neithersimpleintegrationnorsep-
aration, but a blending of the two: ‘. . . the treatment of adolescents is
really a reentryproblemand a debriefingproblem. T h e adolescentis
really a family dropout who has not stayed through his senior year, the
year in which he would gain pre-adult status and which is ended by a
graduation ceremony. H e needs to reenter the family system and separate
to try life on his own’ (Whitaker, 1975).T h e result for the adolescent who
breaks off relations precipitately, or the family which excommunicates its
adolescent member, may be extreme dependence and mutually unresolved
ambivalence in both partsof the family system.T h e dual process of leaving
and of letting go is frequently costly in emotional terms for all involved.
Whitaker (1975) makes this point strongly:
122 H. Jenkins
If the adolescent leaveshisfamily in a self-induced pubertyceremony of
rebellion, if hebreakswith the family without some group resolution of the
problems of symbiosis amongst them, if he leaves without joining in an overt
familyeffort to resolve his desertion-ratherthan by a therapeutic effort to
relieve the individual and group stress-he is stuck with guilt and not free to
instigate a new and creative life. He may then be compelled to reconstruct the
old family again, to work out that senior year and that graduation ceremony at
work, at play, or in his marriage.
T h e therapeutic task is to help the adolescent and his family get free of
past relationship patterns so that each member can either establish satis-
factoryalternativepersonalcommitments,orrenegotiateexistingones.
T h i s period signifies ‘the potential onset of the next generation and the
potential end of the last. Quite suddenly everyone is confronted with the
context of their lives’ (Cooklin, 1979). At this stage family members must
findways of dealingwith the paradox of ‘autonomyinconnectedness’
(Weingarten, 1979),as well asthe physiologicalchanges andintense
emotional responses that accompany puberty.

Treatment choices : a structural framework

Minuchin (1974) and Minuchin et d . (1978) describe the concepts of a
structural approach tofamily therapy. Central to theseideas is the concept
of boundaries. ‘The clarity of familysubsystemboundariesisauseful
parameter for the evaluation of family functioning’ (Minuchinet al., 1978).
All families areseenaslyingsomewherebetweenthetwoextremes of
enmeshment-where the boundaries,orlimitsbetweenmembersare
blurred and differentiation is weak-and of disengagement-where com-
munication is restricted and the boundaries between members are exces-
sively rigid and non-permeable.
Enmeshment and disengagement do not imply qualitative differences between
the functional and dysfunctional. They are terms referring to a transactional
style. However, operations at the extremesdo indicate areas of possible
pathology. . . . The parents inanenmeshedfamilymaybecome quite upset
when a child does not eat dessert. The parents in a disengaged family may not
respond to a child’s delinquent behaviour (Minuchin et al., 1978).
Althoughnoabsolute definition of psychosocialhealthexists, attempts
have been made to define this in general terms (Haley, 1967; Lewis et al.,
1976). An indication of health over time may be provided by a family’s
ability to reorganize in response to the changing needs of its members as
they move through their individual and group developmental stages. More
thanatanystage, adolescence will test the family’s ability totolerate
 ‘Can I leave?’ 123
change, unpredictability, alternating demands for autonomy and depen-
dence, and will lay wide open the vulnerable psycho-social underbelly of
family relationships.
These concepts of boundary and hierarchy are well illustrated by an
example from therapy. T h e referred patient was Simon, a seventeen-year
old boy who was a severely addicted lone solvent user. He was seen with his
parents,hisyoungersister,andfromthesecond session on,withhis
maternal grandmother. T h e parents had lived with the maternal grand-
mother since the day of theirmarriage. In the first session, when the
grandmother was not present, the mother described how her mother had
always looked afterthem, holding her arms wide as she said this. She added :
‘I don’t think we could have survived without her.’ In the fourth session,
when the grandmother and sister were out of the interview room, the
parents and Simon faced a crisis over whether he should leave home for a
while to get separate help. Mother’s explosive response was: ‘Where he
goes, I go’, despite both parents starting the session by stating that they
couldnolongercope. I n fact,theparentshadbegunto cope andset
limits in a realistic way on Simon’s behaviour during the previous five
weeks, but were now in crisis in seeing it through. When openlychallenged
by the therapist on this question of separation, two important issues were
made very explicit. (1) Mother and son enjoyed an over-involved relation-
ship, where the interpersonal boundaries were diffuse, while father was
effectively excluded and disengaged, not only from his son, but from the
mother-son dyad. Such a relationship while functional in a mother-infant
context, was highly dysfunctional for a mother and adolescent son. (2) A
generationboundarywasbeingconsistently-anduntilthen covertly-
breached. Mother’s outburst explicitly opened a further dimension con-
cerning marital relationship issues. T h e marriage had failed to develop as
a separate relationship, perhaps as a consequence of the spouses failing
to escape from being children in relation to the maternal grandmother. In
effect, the parents were similar to parental children in the context of a
three generation map. T h e mother in many ways replicated with her son
the relationship that her mother hadwith her. Finally, mother and grand-
mother frequently formed a coalition against the father in matters relating
to Simon’s behaviour, thus blocking his attempts to be an effective father.
He in turn resorted to impotent threats of violence from time to time,
further reinforcing the females’ beliefs that he could not really manage.
T h e vital transactional pattern was triadic, and demonstrates the patho-
logical effects of perverse triangles (Haley, 1967) in human relationships.
One of the strengths of a structural approach to therapy indealing with
adolescents is theemphasison issues todowithboundariesand
124 H . Jenkins
individuation, with negotiations betweenfamily subsystems and the atten-
tion given to hierarchy. This does not mean to deny the importance of
processesassociated withindividualfunctioning,buttheseare viewed
within that person’s social context.
While it is certainly correct to locate people’s behaviour in the feedback loops
of social group processes, it is also important to recognize that the individual
has a range of responses to these processes (Minuchin, 1979).
A structural framework focuses issues on of individual and group belonging,
andthedilemmas of autonomyversusdependency.Although in effect
complementary characteristics, these are often polarized in the behaviour
of families in crisis. Issues of parenting and of ‘who is running the show’
need to betackled if reentry and separation are to coped be with adequately.
Frequently the therapist has toally with and strengthen the parental sub-
system as a first step towards freeing the adolescent and his family from
one another. This may be illustrated in the case of the P. family. T h e
therapist, a student in training who was being supervised through a one-
way screen, was instructed to deliver a message at the end of the second
session with the aim of delineating the two primary subsystemsof parents
and children, and of enhancing parental rights. T h e father was present
this time, but had not attended the first session. Both parents worked
during the daytime. T h e initialreferralconcernedtheyounger of two
adolescent daughter’s non-attendance at school. However it became clear
in this session that her older sister also missed school regularly. First, a
simple monitoring task was given, then a message in two parts was de-
livered direct to the parents. T h e therapist commiserated with them over
the difficulties of bringing up children today, and particularly when they
are in mid-adolescence. Both parents visibly relaxed at this. Then, con-
tinuing to address the parents, she heavily criticized both girls for taking
advantage of their parents who were working so hard to provide the sorts
of home comforts and benefits that both girls enjoyed.I t would have been
easy to criticize the parents for inconsistent controls, and for failing in
their genuine but ineffectual attempts to solve the problem, but it would
not have been therapeutically useful. T h e unexpected, and important bit
of information to emerge from this ‘ctiticism of the girls’ was the clear
expression of the older girl’s anger at being classed, appropriately, in the
samecategory as her younger sister. T h e graphic way sheshowedher
feelings to her mother about this message from behind the screen also
highlighted a previouslycovertmother-older daughter coalition. T h e
messageboth achieved its desiredpurpose,andacted as a probethat
guided future therapeutic planning.
 ‘Can I leave?’ 125
T h e therapeutic focus should be in thearea of searching for competence
among family membersasaprerequisitetochallengingandchanging
patterns of behaviour. T h e therapist who enters into a rescuealliance with
the adoloscent member will quickly become absorbed in the family crisis.
He risks alienatingandunderminingtheparentsintheirattemptsto
handle thedifficulties, and may even be treated as suspect by the adolescent
himselfbecause of hisviolation of basicgenerationalboundaries. This
does not preclude the making of temporary alliances as strategic moves in
therapy; the therapist must be able to establish and shift alliances with
individual members or sub groupings within the family as ways of joining,
of increasingintensity,and of unbalancing(Minuchin, 1974). Buthis
task is not to rescue one generation from another. Some of these issues are
highlighted in the case example and discussion that follow.

The Williams family: drug abuse with an older adolescent

This case highlights many of the difficulties and checks that a therapist
can encounter in therapy. It is followed by a discussion which points to
some of the pitfalls that could have been avoided.
T h e referred member in this family was Daniel. He was twenty-one
and had been a regular drug user for the past five years. He had twice
been hospitalized during the previous six months, and at the timeof referral
was being maintained on methadone. This referral was obtained from an
addiction unit situated in a large mental hospital, and the family agreed
that the sessions could be video taped for the dual purposes of treatment
and teaching.*
A structural approach, with an emphasis on family hierarchy was sus-
tainedthroughouttheseven session treatmentperiod. I n recentyears
attention has been given to the r6le of the family in the maintenance of
substanceabuse(KlagsbrunandDavis, 1977) withanemphasis on
structural interventions in treatment (Stanton, 1977; Kaufman and Kauf-
mann (Eds.), 1979; Haley, 1980). T h e immediate family is described in
Figure 2.
T h e father ran a small building firm and the mother worked part-time
in a shop. T h e older son, Anthony lived away from home with his girl-
friend and their baby in one of his father’s flats. At the time of referral,
Daniel was living at home, although he didat times stay with his brother,
* This family was seen as part of a workshop presented atthe 10th International
Institute on the Prevention and Treatment of Drug Dependence, Cardiff, 16-20
June 1980. The workshop leaders were: Harvey Jones, Eddy Street, and the author,
who was the therapist for this family.
126 H . Jenkins

MGM
74 years

mid - 40‘s mid-40’s

builder
I ’ Dart-time
shop assistant
Common law
marriage
Anthony Daniel
21

6
Figure 2.

and his father had also bought him a house in the belief that this would
helphimsettleandtakeresponsibilityforhimself.Daniel was notin
work, but receiving state sicknessbenefit. T h e basic approach adopted
was to focusonre-establishingfirmpermeablehierarchicalboundaries
(Haley, 1980).

Session l
T h e aim for this session was to engage the family sufficiently to ensure a
secondsession,andtojoinwitheachmemberwhileavoidingarigid
alliance with any individual or subsystem; to establish a beginning under-
standing of family transactional patterns and so of its structure; to initiate
some family interaction in order to test the relative strengths of different
boundaries; and finally, to leave the family with some form of homework
task that would both further test their abilitiesriskto alternative behaviour,
and to keep therapy ‘alive’ between sessions.
Joining and restructuring manoeuvreswere made both verbally,looking
for points of emotional contact, and by altering the seating arrangements,
and thus the family plus therapist alliances. I t became clear that Daniel
acted as a tension diffuser in the family, supported by at least one other
family member. When the therapist asked the father how they wanted
Daniel to be, he replied : ‘I think Daniel’s the best judge of that.’ Through-
out the session, father attempted to pass responsibility either to Danielor
to his wife. Alternatively,hewoulddisqualifyhis,oranotherperson’s
comments by the use of humour. Mother and son would reinforce this by
cuing each other while he was talking, both further disqualifying him and
reinforcing thestrong mother-soncoalition.Verbal therapeuticinter-
 ‘Can I leave?’ 127
ventionscentredaroundblockingsuchdisqualifyingcommunications,
encouraging family members to speak for themselves, and at times, also
using humour to challenge the family’s transactional patterns, rather than
the individuals p e se.
~ This involved decentralizing Daniel from parental
transactions,makingsurethatheunderstoodwhat was goingon,but
progressively shortening his monologues concerning drug abuse, or other
socially failing behaviour. This also challenged the family’s preferred
behaviour patterns, since it became increasingly difficult for the family, or
therapist,tohidebehind Daniel’sverbalsmokescreen.Parallel tothis
process, changes in physical space were used to mirror emotional shifts.
Hencetheseating wasalteredduringthefirsttwentyminutes of the
session, as shown in Figure 3. Family interaction closely mirrored that
described by Haley (1980) of the young person addict consistently occu-
pying an over central position in his family. This situation might lead the
therapist to speculate on the function of the young person’s behaviour in
terms of the marital relationship, but Haley warnsof the dangerof dealing
explicitly with maritalissues before resolving the drug problem. Only once
this has been achieved should the therapist consider makinga further

Daniel
MO. 0
Fa. 0
0
> Cameras Initialseating

OO
T h.

Daniel
0
MO.0
Fa.0 >Cameras First move by
therapist, at point
Th?
of attempting to
join more with
father.

>Cameras Therapist
Th.0 movedDaniel to
Daniel sit by therapist
in order to:
( a ) separateMo-son
coolition;
( b ) ally therapist
withDaniel, but
also to;
( c ) beable to
include or exclude
himmore effective-
ly, os seemed
appropriate.

Figure 3.
128 H . Jenkins
contract to work on marital issues if requested. A premature diversion to
marital workmay itself be a manoeuvre by the family to sidestep the
issue of theyoungperson’sfailuretoestablish himselfadequately in
society. I n extreme instances, the physical survival of the addict may even
not be the prime concern of the family (Stanton, 1977).
T h e parents were instructed during thesession to discuss together their
hopes for Daniel. Such a manoeuvre broughtback himinto the transactions,
and the therapeutic task was to help the parents have him stay out. The
mother appeared ready to talk to her husband, as though some sort of
release, but he was reluctant, saying in rapid succession: ‘We don’t need
to talk to each other . . . we are so finely attuned to each other that either
can speak for us both . . . Can I say something irrelevant here? . . .’ T h e
problem for the therapistwas to challenge father’s counter-flanking moves
byalteringtheirhabitualways of dealingwithclosenessandpossible
conflict without attacking him personally.
I t was clear from this session that Daniel lived at home very much on
his terms, with his parents apparently waiting on him. For example, they
would lie in bed half awake until 5.00 a.m. or later, waiting for him to
return home. Hewould come to the open bedroom door to let them know
that he wasback, ‘so theydon’tworry about me’. He enjoyed all the
comforts of home, but was not expected to make any financial or other
contribution to his upkeep. It seemed appropriate to set the family one or
more tasks to attempt between then and the next session. Although there
were a number of areas where tasks could have been set, the first goal
was to engage and challenge the system in a way that would make it pos-
sible for the family to return for a second session.
A contract was made with the family for a further six sessions. T h e
main focus was to engage the parents primarily, and to obtain Daniel’s
agreement and understanding about whatwas negotiated. T h e tasks aimed
to put the parents in chargea way in that would eithertake care of systemic
issues, or that would at least show up areas of difficulty for future work.
T h e two homework tasks were: (1) Father was put in chargeof dispensing
Daniel’s methadone daily until the second session. This stemmed from
Daniel’s admission during the session that he had been unable to ration
himself consistently, and had been mixing it with alcohol. T h e times for
Daniel to take these were negotiated according to his father’sconvenience.
(2) Daniel was to clear up some of the builder’s yard at the back of the
house. This had been a source of irritation to his mother, and his father
was put in charge of Daniel doing this for her.
It is clear in retrospect that certain issues were only partially dealt with
at the time. It is probable that with a consulting team observing in vivo
 ‘Can I leave?’ 129
a more comprehensive therapeutic strategy could have been planned. First,
after the arrangements had been made between father and son regarding
the medication, and both parents appeared to be in agreement, mother
turned to Daniel, and asked: ‘Is that all right with you?’ She thus dis-
qualified her husband and the therapist by putting theofarea final decision
back with Daniel and ultimately with herself. Second, when father had
been put in charge of making sure Daniel did something which would be
helpful for his mother, she commented in an unassuming manner to her
husband: ‘Of course, you have often asked him to do this, but he never
takes any notice’. Although this was reframed as being different because
thetherapistrequiredittobedone,it lacked sufficient intensityto
challenge the mother-son coalition versus father. Third, it was over am-
bitious to set two homework tasks at this stage. I t would have been strategi-
cally more effective to focus on regulating the supply of methadone, and
tohaveframeditintriadicinteractionalterms.Thisfocusalready
challenged the family’s habitual patterns, because in setting the task, it
became clear that mother had previously been mostclosely involved with
Daniel in this area. I t is unwise to attempt too much too soon, especially
with families who have an addicted member. Klagsbrun and Davis (1977)
quote Wellischwho maintains that drug-abusing families ‘(are among)
the hardest families to treat, but thefamily approach is theonly approach
that will work’. Although an extreme claim, it seemslikely that the issues
of reentry, differentiation, the renegotiation of family interrelationships,
and of separation associated with adolescence in the broadest sense of
fifteen to thirty years, are intensified around life threatening situations
such as drug abuse (Stanton, 1977), serious suicide gestures (Richman,
1979) and severe psychosomatic illness (Palazzoli, 1974; Minuchin et al.,
1978). T h e processes frequently associated with pathology during ado-
lescence areinthemselvesnormal.‘Thereissomeevidencethat all
families go through a regressive phase during the adolescence of an off-
spring, their temporary disturbance paralleling the adolescent’s turbulent
stage of development’(KlagsbrunandDavis, 1977). It is, however, in
extreme instances that these processes are most dramatically highlighted.

Session 2
T h e family’s preferred coping abilities had been stressed during the first
session. I n t h e second there was evidence of family retrenchment. Both
taskshadbeenattempted,without real success orfailure.Fatherhad
begun by taking charge of medication, but mother had taken over when
Daniel had obtained his repeat prescription. Father had finally made sure
130 H . Jenkins
that Daniel did some clearing up during the two days before the second
session. I n both instances, it was particularly difficult to gain any clear
definition of how individuals took responsibility for action, but it helped
.highlight Daniel’s lack of internal and interpersonal boundaries in terms
of what behaviour was expected of him.
During the session, Daniel’s behaviour becameincreasingly distracting.
As the therapist began to get a report from the parents as to how they
had carried out the tasks, Daniel elected to move to the seat next to him.
Mother commented with a nervous laugh: ‘Separating Daniel from his
parents !’ At the same time, he began to ramble about his strange feelings,
loss of concentration, and confusion over days the previousweek, thereby
effectively, although only temporarily, protecting his parents from a situ-
ation of possible conflict. T h e theme for this sessionwas the parents’
expectations of Daniel in terms of behaviour, and therefore implicitly of
what they expected from each other as parents. Theirfear of losing Daniel
seemed to paralyse them aseffective parents. Despite a realistic worry that
he might resort to drugs, the main anxiety seemed to centre on him growin
up and leaving home.

Session 3
This was given over to seeing the parents without Daniel, and attempting
to strengthen further the executive part of the family system. I n so far
as they tended to think only in terms of Daniel’s wishes, the focuswas to
consider what rights parents have in deciding how their home should be
used. T h e crisis was to come in the fourth session, since in one sense the
therapeutic thrust had been too successful, and Daniel was unready toface
parents who were beginning to work together. Their new found alliance
was also too fragile to withstand much pressure from him.

Session 4
T h e parents were seen together at the start
of this session to give them time
to discuss the outcome of their tasks. They had been directed to come to
an agreement on house rules for Daniel to be up in the mornings to eat
breakfast with them, and also for coming in times at night. Mother had
been put in chargeof getting Daniel up in the morning, while father was to
be ready to support her should there be any difficulties. Finally, they had
toreachanagreementonwhenDanielshouldstart lookingfor work
actively. Both reported some continuing improvement, but they strongly
resisted takinganycredit,fearinga relapse it seemed.Bothremained
 ‘Can I leave?’ 131
anxious that he might leave home, either to return to the addiction unit,
or to make his ownway in the world.
This proved to be pivotal
a session where both parents started exercise
to
more appropriate executive functions, and where Daniel became increas-
ingly upset and sullen at his parents’ improved abilities to work together.
T h e parents had not been able to set a date for Daniel to be out looking
for work, so this became a first task in the session. Father expressed his
worries about upsetting Daniel, saying that he can tell Daniel what to do,
but that he then backs down on what he says. He added: ‘I have to do a
lot of backing down’, both in terms of Daniel and of his wife. T h e main
circular interactional pattern appeared to be as shown in Figure 4. It was
critical that away be found to help the parents take effective joint responsi-
bility for Daniel taking responsibility for his behaviour. They became more
active in the session, and the therapist could assume more of a guiding
function.TheybegantosetreasonablelimitsforDaniel’sbehaviour.
However, he objected strongly when they began to say they expected him
to pay a reasonable proportion of his sickness benefit towards his upkeep.
As they were helped to agree a reasonable weekly contribution, Daniel
became more upset and childlike. While mother appeared able to keep
somepressureonDaniel,father began to waver. Atthispointfather
switched abruptly and redefined Daniel’s problem as a form of ‘mental
sickness’. T h e therapist reframed this as: ‘The biggest habit that Daniel
has to kick right now is laziness’, thereby keeping the problem within a
framework of failing behaviour, over which the family could be expected
to exert some influence, rather than one of a medical condition such as

y
Doniel: behoves
ptably,

MO: intervenes to
‘rescue’ the Fa reprlmands,
menfromeach
other, and to
calmthesituation:
/
Daniel:does not
conflict ovoided.
readilyaccept
reprimand.

\ J
Fa: backs down- there are
‘bad feelings’ between
the two males,

Thecorollorary to this sequence IS thatfatherbecomes less

active as he feels moreunable to ‘father:andmother becomes
more intensely Involved with Daniel as a compensation for
father ‘not shouldering his responsibilities:

Figure 4.
132 H . Jenkins
‘mental sickness’ or ‘physical addiction’ over which onlythe experts might
makedecisions. This theme was maintainedfortheremainder of the
session, relating it to whether Daniel was only ‘sick’ until he found work,
or whether he should be registered as unemployed. Daniel’s response to
this challenge to take more responsibility forhimself was : ‘Well, I’d rather
move out’. Although the parents came to an agreement with Daniel about
contributions towards upkeep, and how this should be paid, together with
what he should do to look for work, his covert ultimatum was not dealt
with fully in the remainder of the session.

Sessions 5 and 6
Daniel did not come to either session. There appeared to be a considerable
retreat by thefamily from change, and the parents demonstrated their lack
of cohesion by coming without Daniel. They both thought it better to
hold ontO the little they had than to risk losing Daniel completely. Father
agreed that Daniel was not ‘mentally ill’, but felt unable to push him
further. They stated that when he was ready to ask for more appropriate
independence, they would give it to him. They wereback to waiting upon
him, and independence given with thatsort of permission is of a different
order from that which is wrested by the individual. Between the fifth and
sixth sessions, it was also learnt from a telephonecall made to the addiction
unit that Daniel had returned to outpatients and obtained a further fort-
night’s supply of methadone, without anyone being notified of this. T h e
parents were given this information in the sixth session by the therapist,
and asked why they should continue to come when the person with the
problem was Daniel. Father was particularly angry at this news,but in the
final session had ‘forgotten’ that he had been so. T h e only condition for
seeing the family for the next, and final session of the contract, was that
Danielshould come, withit wassuggested,hisbrotherAnthonywho
might give him some support.

Session 7
Mother did not come to this session, because her mother had become
seriously ill and been admitted to intensive care. Father and the two sons
came. I t appeared that Daniel had been for an interview for a job. He had
left home to live with his brother for afew days, but had come back at the
news of his grandmother’s illness. Father affected not to know that Daniel
had even been away from home. T h e father-son relationship was at a low
ebb, and Anthony replicated his father’s pattern of supporting everyone
 ‘Can I leave?’ 133
and no one. Therapy with this family had come full circle. Daniel had
successfully split the professional systems involved with him by obtaining
a further prescription of methadone ; father appeared not to remember
anything of the previous session now that hiswife was not there with him ;
and Daniel was being covertly supported by his older brother in his current
life style.T h e very daythat father had taken Daniel to G.P.
the to be signed
off the sick register, Daniel had gone straight from surgery to obtain more
medication. It therefore seemed appropriate to leave the family with the
problem of whethertheywantedfurtherhelpwithDaniel’sproblem.
They did not make furthercontact. Subsequent follow up with the addic-
tion unit revealed that Daniel was continuing to anger the medical staff
with his apparent helplessness, while at the same time receiving repeat
prescriptions of methadone.Although the outpatient service there is
exasperated with his antics, it appears to be as hard for professionals to
be firm with him as it is for his parents.

Discussion
This case was chosen to illustrate some of the issues discussed in the first
part of this paper because it highlights many of the difficulties that the
therapist can expect to meet in work with adolescents and their families.
It is tempting to present work that has been predominantly successful.
The nature of thepresentingproblemmadeita particularlydelicate
therapeutic undertaking. It is the author’s belief that often more may be
learnt from instances when strategies fail than when they are apparently
successful,
Prior to the referral, Daniel had been a patient in an addiction unit
based in a large psychiatric hospital. Although the parents had met with
the medical staff, treatment had been individually focused. T h e referral
was made partly because the referrer felt it likely that the family would
agree to be seen together, and partly because other forms of treatment had
failed to bring about any significant change. T h e expectation of obtaining
teachingmaterial further complicated the engagement process,and the
therapist failed to engage the full operative family system at the beginning.
This made it especially difficult to bring the older son into therapy later
on when it was clear that more resources were needed to help consolidate
the little improvement already made. Frequently therapyfails because the
therapist moves too quickly and the family takes flight. In this instance,
had a stronger therapeuticalliance been established earlier,and had Daniel
been treated more effectively in terms of inter-generational boundaries at
the beginning, itis probable that the whole family would have maintained
134 H . Jenkins
greater motivation to work towards change and increased competence. I t
might have been strategically useful early on to challenge whole the family
to consider the dangers of change for them as a group, as a means of
uncoveringthe covertlyoppositionalnature of the family’s behaviour
patterns. Such an intervention could have created a pivotal crisis point
(Jenkins, 1980) and challenged the enmeshed redundant sequences.
T h i s approach was used effectively withthesubsequentreferral of
another family from the addiction unit in order to force a crisis between
the first and second sessions with the Lewisfamily. It was directed to the
mother of a twenty-one year old girl heroin addict, and created consider-
able useful conflictual material for work with a problem as a result clearly
accepted in interactional terms by the family.
When the video tapes of the sessions were reviewed, it became clear
that the family’s interpersonal relations might be characterizedas pseudo-
mutual in the senseof ‘a predominant absorption in fitting together at the
expense of the differentiationof the identitiesof the person in therelation’
(Wynne et al., 1958). Father had appeared the most difficult member to
engage, and much effort was spent in allying with him. T h e aim was to
strengthen the parental subsystem, but it implicitly challenged mother’s
central r81e without offering her an alternative function. Minuchin (1974)
warns of the dangers of focusing on one subsystem in a family at the
expense of another if this frameworkis adopted. I n so far as thiswas never
fully resolved, a weakness underlay all strategies directed at strengthening
their executive d e s .
Just as generational boundaries were covertly breached in thefamily, so
inter-agency professional boundaries were crossed, resulting in a replication
of the family’s ‘perverse triangles’ (Haley,1967). Despite agreement at the
point of referral that the therapist would be directly responsible for treat-
ment,andthatmedication wouldonly berestartedafterconsultation
between the addiction unit team and the therapist, this subsequently broke
down. Whereas the referring psychiatrist was in agreement, a junior col-
league at the outpatient clinicwas not fullyinvolved in thedecision making,
and initially refused to discuss any aspectof treatment with the therapist.
This raises two important questions. Should treatment have been started
without a full discussion with all medical, and nursing staff who had pre-
viously been involved?What happens when two modes of treatment collide,
and ethical problems over confidentiality and professional territorial limits
conflict? From the junior doctor’s viewpoint, thereexisted a dilemma over
theethical issue of discussingpatient-doctor decisions, despitethe
original agreement. At the endof the fourthsession, Daniel had been upset
at the way he was losing ground with his parents, and he returned to the
 ‘Can I leave?’ 135
outpatient setting where heknew he had a good chance of having his way.
Implicitly,apowerstruggledevelopedbetween professional groups,
initiated by Daniel in an attempt to meet his own feltneeds. No one
outside of the outpatient setting would have known of this change of
circumstances if the therapist had not kept to the original terms of the
agreement by making sure that the otherprofessionals involved were kept
informed. This situation had thepotential to replicate in terms of process
and affect, the conflict resolving patterns of the family in treatment. Al-
though Daniel’s solution defused the problem for him in the short term,
it also confirmed him in his career of failing to takeresponsibility for
himself. On a broader plane, it is arguable that part of the original treat-
mentsystemexperienced difficulty inseparatingfromthepatient. To
this can be added the proviso that collusion in that quarter by supporting
Daniel not to return to therapy with his parents if he did not want to
because he had been upset in the fourth session, was probably a critical
factor in subsequent treatment difficulties. It underlines Haley’s contention
(1980) of the necessity for the therapist to have the final decision about
whether to readmit or medicate, even if the therapist himself is not an
immediate member of that system, and evenif he is not from the medical
profession.

Conclusion
T h e between age of adolescence is frequently characterized by unpredict-
ability and extremes of behaviour, both in the adolescent, and in other
family members. T h e therapist who chooses towork with adolescents will
have to grapplewithintenseemotionsanddisturbingbehaviour. The
physical ability to carry out childhood phantasies make this area of work
all the more demanding. However, an exclusivelynarrowfocus on the
individualwouldbetomiss a richareaforchange. T h e therapeutic
paradox is frequently to help adolescents and their families find alternative
ways of getting closer, all the better to separate. Myimpressionfrom
working in this field is thatattemptsto rescue adolescentsfromtheir
families because of the perceived harmful effects that families may have
on adolescents in trouble is as likely to exacerbate the problem for all
concerned as to ease it. Adolescent pain is but one dimension of family
pain. I n extreme circumstances this can result in bizarre behaviour, as in
the case of Sandra W. At fourteen she had been diagnosed schizophrenic
and had undergone a course of ECT. When seen in treatment, it became
clear that one function of her bizarre behaviour was to draw attention to
herself everytime that the therapist put the parents under pressure that
136 H . Jenkins
would seem to lead towards conflict. By working on the hypothesis that
Sandra’smadbehaviourhadanimportant protective function, it was
discovered that her parents had been on the point of separating at the time
that she was conceived. Her next oldest sibling was fourteen years her
elder, and so, almost alone, Sandra had carried the responsibility for the
continuation of the marriage upon her shoulders. Madness, and an abdi-
cation of responsibility were a relatively low price to pay for ofloading an
intolerable burden. Sadly, before she was referred to an adolescent unit,
the treatment given had colluded in the myth of her individual madness,
and her psychotic state was, in part, iatrogenic.
T h e range of presenting problem in work withadolescents is wide.
There are distinct management issues depending on the extent to which
the individual or others may beat physical risk. At this time too, there are
important physiological changes, and there are a number of fundamental
themes associated with individuation and identity ; with belonging and
separation ; with intense emotions that cannow be acted on for real ; with
a desire to experiment. If these themes are to be developed and channelled,
it seems important that the social structure within which the individual
lives should be dealt with, and that the therapist canlearn what the issues
are in each instance from thetangles that a family’s organization gets into.
A structural hypothesis that Sandra W. was triangulated (Minuchin, 1974)
with her parents, and that they also detoured conflict through her, provided
an operational map on which strategy could be planned. In the case of
Daniel, the route was fairly clear, but faulty decisions were made about
which part of the family to ally with, and eventually group anxiety about
loss and separation became stronger than the need to change.

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