Some Troubled Teens Tap Well of Resilience

Narratives of troubled adolescents who successfully turned their lives around reveal adaptive skills associated with resilience, how these skills function, and how they can be nurtured in resilient children.

These findings come from a long-term longitudinal study of high- and low-risk adolescents conducted by Stuart Hauser, M.D., Ph.D., a professor of psychiatry at Harvard Medical School and Joseph Allen, Ph.D., a professor in the University of Virginia's Department of Psychology. A report of their work,“ Overcoming Adversity in Adolescence: Narratives of Resilience,” appears in a special issue of Psychoanalytic Inquiry, published in January by the Analytic Press.

To investigate why some troubled kids defy the odds and become emotionally healthy adults, the investigators followed 70 adolescent patients on locked psychiatric wards. All had histories of violence and self-destructive behaviors including suicide attempts and drug abuse. All were in trouble with the law, their schools, and their families. (For study methodology, see Original article: “Parents, Teens Try to Heal Wounds.”)

Fast forward 12 years. While most still struggled with their demons, nine of the group were found to be emotionally healthy adults leading normal lives. This pattern held true when they were interviewed again at age 25.

When new interviewers expressed surprise that such well-adjusted people were ever in therapy, the researchers decided to undertake a person-based, follow-back analysis of the adolescents' multiyear, transcribed narratives to see if they could predict which kids turned out to be resilient. They concentrated on the nine resilient young people and contrasted their narratives, not with those who did not recover, but with sociodemographically similar high school students.

“The overarching goal was to gain a better understanding of how resilient development unfolds,” Hauser told Psychiatric News. As researchers re-read the narratives, Hauser said they were not expecting to find “successful adaptation” or competence in the teenagers' narratives but markers and positive signs of development potential.

Such markers are particularly difficult to spot in adolescence, according to Hauser, because unruly and deviant behavior may disguise creative efforts toward self-understanding. He said that behaviors that worry parents, caregivers, police, counselors, and educators are sometimes a young person's best strategy for survival. What is seen as negative and even dangerous behavior can actually be hiding a positive and healthy search for resilience.

Three Factors Stand Out

The case studies revealed three protective factors associated with resilience that appeared to be crucial. All the resilient individuals exhibited the capacity and confidence to steer their own lives. They were aware of how their behavior had contributed to their lives not going well. Unlike less adaptable kids who tended to externalize their problems and blame others for their misfortune, the resilient youth assumed responsibility for what happened to them.

All the resilient kids were also extremely good at reflection. They could look back on their past and think about their behavior and what had happened, perhaps even better than “normal” kids at that age, according to Hauser. Typically resilient kids told compelling stories and kept their ideas and feelings together. Their narratives were coherent and smooth.

Probably the most important trait, said Hauser, was their ability to form and maintain relationships. “While most resilience studies cite relationships as extraordinarily important in doing well in life, these kids knew this at a very early age, and almost all had one or more special relationships that helped them get through their problems,” he said. They didn't randomly form attachments but picked people who could help them. Many “earned security” by making good attachments that helped them over rough spots. What the successful ones found helpful was learning to abandon friends, particularly noxious friends such as fellow addicts, to help them survive.

Other well-established protective factors in adaptable kids were tenacity, optimism, and a belief that life had meaning. Resilient kids were often doggedly determined to see things through, had a healthy curiosity, and were not afraid to question things.

Treatment Noncompliance Common

One discordant note echoed through the narratives. Resilient kids were often noncompliant with treatment. In a show of independence, most of the resilient youngsters rejected the hospital's postdischarge recommendations. Instead they went their own ways and found things that usually helped them establish constructive lives.

Hauser believes the strongest practical message that came out of the study is for psychiatrists to look for competence as well as disorder when seeing troubled kids and teenagers. He said it is unusual for clinicians to look closely for competence in troubled youth, because they are understandably so often aware of the adolescent facing serious, often acute, overwhelming vulnerabilities and dire circumstances. So they tend to tune into incompetence more than competence.

“Yet as vividly displayed within the narratives of our nine adolescents who became resilient young adults, there are many compelling reasons for mental health practitioners and family members to search for and do everything possible to encourage teenagers' strengths—temporarily buried under the wreckage of a brieflife—so they can begin to grow again and push upward,” he said.

Andrew Gerber, M.D., Ph.D., a research fellow in child and adolescent psychiatry at the New York State Psychiatric Institute, called the resilience study “rich and thought provoking” and noted that Hauser and Allen not only listened to their patients but also went a step further by listening to their interviewers.

“From them they learned that quantitative measures alone do not adequately capture the themes of lifetime trajectories most predictive of good or bad outcome. So they created a new technique for applying narrative analysis to a longitudinal set of interviews.”

He cautioned, however, that the person-based, follow-back technique is not meant to replace the time-honored tradition of developing quantitative measures to test these hypotheses in a specific way. ▪