Obstacles in moving through the developmental stage of autonomy vs shame can lead to teen narcissism and defiance. The anger displayed by teens can best be understood by having empathy for the underlying core emotion of shame. Parenting, teaching, and health care counselling strategies are offered to help a young person mature into a resilient, healthy and autonomous individual.

1. Help me find myself
The Struggle for Autonomy
Todd Kettner, Ph.D., R. Psych.
School District 8
1
December 15, 2014
CYMH Collaborative

2. Diagnosis –arrested development vs.
symptom description
• Dr. John McKinnon “An Unchanged Mind”
• Understanding our students entails an attention to
the obstacles that delayed their development
AND an awareness of their immaturity
• Effective treatment then entails
• Removal or mitigation of obstacles that delayed
psychological development
• Encouraging and prodding a stuck teenager to
GROW UP
December 15, 2014 CYMH Collaborative
Todd Kettner, Ph.D., R. Psych. School
District 8
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3. A quick review of Erickson’s
Developmental Stages
December 15, 2014 CYMH Collaborative
Todd Kettner, Ph.D., R. Psych. School
District 8
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4. A word about DSM diagnosis and
medication
• Focusing on the push for maturity
does not mean ignoring psychiatric
disorders or pharmacological
treatments.
• It’s a matter of emphasis
• Remember….
we reinforce what we focus on.
December 15, 2014 CYMH Collaborative
Todd Kettner, Ph.D., R. Psych. School
District 8
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5. Key Issues of Delayed Maturity
STAGE
(month
s)
KEY TASK OR
STRUGGLE
CHARACTERISTICS TYPICAL
FAMILY &
LIFE ISSUES
HELPFUL
RESPONSE
0 - 12 Attachment Lack of trust, poor
boundaries
“I don’t know if I exist.”
Adoption,
abuse,
neglect,
chaotic
Predictable
Nurturing
Attuned
6 - 18 Separation/
Individuation
Anxious, moody,
enmeshed, collapses
under stress
“I can’t be alone.”
Overprotective
parents,
enmeshed,
poor limits, no
hierarchy
Attuned
Reassuring
Encourage
independence
Available
18 - 36 Autonomy Securely attached,
individuated but angry,
resist authority
“You can’t control me.”
Giving in to
tantrums, no
limits,
overpowering
Clear,
consistent
limits w/o
power struggle
Reassuring
December 15, 2014 CYMH Collaborative
Todd Kettner, Ph.D., R. Psych. School
District 8
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6. “You Can’t Control me!”
December 15, 2014 CYMH Collaborative
Todd Kettner, Ph.D., R. Psych. School
District 8
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7. “I’m so Special.”
December 15, 2014 CYMH Collaborative
Todd Kettner, Ph.D., R. Psych. School
District 8
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8. Characteristics of an autonomy
struggle Teen
• Angry
• Direct – “You can’t control me!”
• Passive – “I’m so special that expectations don’t
apply to me.”
• Shame – anger towards oneself for being
inadequate
• Key anxiety - Fear of being exposed
• Resistant to authority
• Key issue – “You’re not the boss oDfe cemmbeer 1…5, 20”14 CYMH Collaborative
Todd Kettner, Ph.D., R. Psych. School
District 8
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9. Narcissism in teens
• The world revolves around me
• No one can tell me what to do
• I am unaware of and/or don’t care about others
feelings and needs
• Can lead to holding in feelings of shame, anger, hurt
which then explodes intermittently (hey that sounds
like a psychiatric diagnosis)
• Pushes others away – leads to social failures/isolation
– leads to further feelings of inadequacy and shame
December 15, 2014 CYMH Collaborative
Todd Kettner, Ph.D., R. Psych. School
District 8
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10. “I don’t have to Listen to you…
I’ll be sad or angry if you say no”
December 15, 2014 CYMH Collaborative
Todd Kettner, Ph.D., R. Psych. School
District 8
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11. Poorly resolved early autonomy
struggle
• Self-centered
• Entitled
• Lacking in empathy
• “pseudo adults” – haven’t
done the work or earned the
right to be legitimate adults
• Lacking emotional availability
• False sense of self that is
easily wounded
December 15, 2014 CYMH Collaborative
Todd Kettner, Ph.D., R. Psych. School
District 8
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12. Healthy resolution of autonomy struggle
(ages 2 to 4)
• Certain level of
legitimate
independence
• Understand
restrictions and
limits on their
freedom
• Acceptance of
authority
December 15, 2014 CYMH Collaborative
Todd Kettner, Ph.D., R. Psych. School
District 8
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13. Why is Tyler looking
down?
Is he scared?
December 15, 2014
CYMH Collaborative
Todd Kettner, Ph.D., R.
Psych. School District 8
13

14. “Look what I just did!”
MORE
IMPORTANTLY:
“look at who I am…”
Brave
Adventuresome
Talented
Capable
Independent
Strong
December 15, 2014
CYMH Collaborative
Todd Kettner, Ph.D., R.
Psych. School District 8
14

15. Though I’m too
scared to go as
high as my little
brother, I’ve
climbed way up
here too!
December 15, 2014
CYMH Collaborative
Todd Kettner, Ph.D., R.
Psych. School District 8
15

16. I am….
December 15, 2014
CYMH Collaborative
Todd Kettner, Ph.D., R.
Psych. School District 8
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17. I am…
December 15, 2014
CYMH Collaborative
Todd Kettner, Ph.D., R.
Psych. School District 8
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18. Clinical ParentinG
1. A teen’s need for recognition and limit-setting prod her to take the
next step in maturity
2. Setting limits is critical in the context of recognition
3. Useful recognition and limit-setting only take place within a
relationship
4. Parenting is a task that must change at each developmental level
5. Maturity is not just information and skill, but a cognitive and
emotional approach to the world and others
6. Well-timed recognition and limit-setting propel teens towards
positive character development
- From McKinnon “To Change a Mind”
December 15, 2014 CYMH Collaborative
Todd Kettner, Ph.D., R. Psych. School
District 8
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19. Responding well
• Avoid power struggles… AND…
• Set firm limits – with expectations and consequences that are
clear and consistent
• Provide choice within the expectations
• Mentor – guidance and assistance and reassurance
• Encourage mature responsibilities and genuine behaviors
• We’re the substitute punching bags for awhile (may be several
years of conflictual relationships with teachers and parents)
• Coach, model and expect that parents will be strong members of
the treatment team by supporting limits and consequences
December 15, 2014 CYMH Collaborative
Todd Kettner, Ph.D., R. Psych. School
District 8
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20. Success Earned
• Recognition is
deserved
• Success is achieved
• Sense of self is
developed
• Autonomy is gained
• Purpose is defined
tkettner@sd8.bc.ca
December 15, 2014
CYMH Collaborative
Todd Kettner, Ph.D., R.
Psych. School District 8
20