CHAPTER 5

Normal Child and Adolescent Development

Karen Gilmore, M.D.

Pamela Meersand, Ph.D.

Theories of development, either explicit or implicit, are ubiquitous in scientific approaches to the human psyche. In this chapter, we propose a psychodynamically oriented multisystems approach to human development. We present psychological development as a series of hierarchically organized, individually unique and yet recognizable mental organizations corresponding to the familiar divisions of childhood: infancy, toddlerhood, the oedipal phase, latency, pre-, early, mid-, and late adolescence, and emerging adulthood. We hope to show how the interaction of multiple systems, ranging from tangible physical maturation all the way to the intangible development of unconscious fantasy, produces infinite variations of the universally identifiable phases traversed as children progress through life. In the language of systems theory, these phases are attractor states—that is, novel configurations individually and idiosyncratically composed out of multiple interacting systems but nonetheless recognizable across individuals. These states self-organize by virtue of development in each contributing component; they replace each other sequentially by reconfiguring or discarding old elements and introducing new capacities. The results are quantum shifts in personality organization. Thus, periods such as latency or adolescence are different—differently shaped, paced, and experienced—in each individual but are simultaneously identifiable in everyone. Such a theoretical perspective ensures that fluidity, unpredictability, and dramatic shifts are expected in the context of recurrent tropes of the human developmental progression.

There are a few fundamental features that distinguish psychodynamic developmental thinking from many other developmental perspectives (Table 5-1). Perhaps the most basic is our emphasis on the subjective experience of development, which forms the basis of the autobiographical narrative that is part of everyone's mental life, whether conscious or unconscious. This narrative usually becomes clear in the course of a psychodynamic therapy and is often radically revised during treatment. Subjective experience unites many of the features emphasized in a psychodynamic perspective.

Another fundamental theme is the role of the body. The psychodynamic approach strongly emphasizes the importance of the body in mental life. Indeed, mental life or consciousness is grounded in bodily function and experience, and the body propels development forward through its maturation. Yet it is the meaning of the bodily transformations that challenges the mind, because each new physical change, capacity, or limitation must be incorporated into the self-representation. The body exerts this pressure throughout development in a variety of ways. The normal process of growth varies in its pace within the individual during different phases, in addition to varying greatly among individuals. Puberty and early adolescence are familiar examples of explosive bodily transformations that place enormous demands on minds contending with a host of new capacities and feelings—reproductive, sexual, interpersonal, and cognitive. The differences in a given cohort in regard to the bodily changes also accrue meaning and must be grappled with; children who are "delayed" or "late bloomers" struggle with their own self-image, parental reactions, and their standing among their peers in terms of their sense of themselves as competent young teenagers.

In the course of development, we also single out evolving ego capacities as a crucial feature. Ego capacities emerge from the interaction of endowment (in itself an unfolding contribution as new functions come online throughout the first two decades) and the environment; the experience emerging from this interaction interacts in turn with other developing systems. Although difficult to tease apart in "normal" development, discrepancies and unevenness in the emergence of ego capacities, especially in childhood, bring into relief their crucial role in ongoing interacting developing systems. The concept of ego capacities includes aspects of cognition, self-regulation, defenses, emotional repertoire, object relations, and self-reflection that emerge in a roughly invariant program, provided the environment offers essential nutriment for their appearance.

The last-mentioned provision is encompassed in the emphasis on environment, both human and cultural, in shaping the path of development. The family is the most immediate and powerful influence brought to bear on the mind of the developing child; the interpersonal world is a powerful shaper of personality and subjectivity. Moreover, it is through the prism of the family that the impact of the larger society is mediated early in life. As the child moves out of the family orbit, the influence of the broader culture is encountered directly. Some of the idiosyncrasies of a given culture are, of course, only evident in encounters with a different one, but this is a common occurrence in contemporary Western society; for example, semesters abroad can be disorienting on both ends, because the new culture demands adaptation and destabilizes the "fit" of the native culture. It is no small challenge to stand outside of one's own society in order to be neutral in consideration of the development pressures of different cultures, but this is a feat frequently required in our therapeutic encounters with patients. An enlightened developmental perspective attempts, at the very least, to alert us to these culture-specific features.

The psychodynamic viewpoint is wedded to certain notions of how the mind is organized, and we continue to find these useful in considering the development of the person. We incorporate the notion of the dynamic unconscious as a backdrop. In terms of mental structure, we have already mentioned the ego, which we see as a broad collection of capacities, including cognitive components, defenses, and self-regulatory functions. In addition, we focus on drives, impulses, and unconscious fantasy (the id) and the emergence of the superego. We assess these features as we contemplate an individual in a given point in development while maintaining an awareness of the resilience and promise of the developmental engine that can self-correct and repair.

With the complexity of a multisystem view as backdrop, we incorporate some traditional conceptualizations of development as they continue to be useful. This applies to psychosexual development, Freud's first theory, which remains clinically relevant, provided it is embedded in a more comprehensive context. Similarly, aspects of Mahler's separation-individuation paradigm are still helpful, especially when integrated with attachment theory. We take the position that these are like the various perspectives of the blind men and the elephant; if we remember that there are many other systems operating and interacting, we can come to an understanding of the whole entity that is human development.

Infancy and the Beginning of Mental Structure

Psychological Life of the Parent

Well before their child is born, parents' early memories, relational history, and psychological conflicts begin to coalesce around the imagined and anticipated baby. During the latter stage of pregnancy, the mother's increasingly inward focus—the primary maternal preoccupation—prepares her for the arrival of the newborn, fostering a unique openness to the baby's profound needs and an empathic identification with his or her nonverbal signals (Winnicott 1956). Fathers and expectant adoptive parents describe similar experiences as their mental lives center more and more on the baby's imminent arrival. Beginning at birth, the mother's and father's unconscious reactions to the neonate's gender, temperament, and developmental needs powerfully shape their handling of the child. Indeed, parental accounts of their own childhood experiences and their attitudes toward relationships have proven highly reliable predictors of the baby's eventual relational patterns (Fonagy et al. 1993).

The newborn is innately equipped for social responsiveness: remarkable capacities for self and other awareness and for the organization of interpersonal information have been well documented (e.g., Gergely and Watson 1996). Behaviors that are available at or soon after birth, such as sucking, crying, and smiling, help the baby seek and maintain proximity to the parent. These are manifestations of a biologically based' attachment system (Bowlby 1969) that ensures the infant's physical and emotional survival. However, the helplessness and dependency of the young infant are inescapable and evoke strong responses in the mother and father. Immediately after birth and throughout the first decade of life, the child leans heavily on the caregiver's ego capacities—in particular, the adult's ability to mirror and modulate intense affects—for the gradual acquisition of internalized, autonomous self-regulatory functions.

For parents with psychiatric vulnerabilities or severe environmental stressors, the emotional and physical demands of the newborn can seem daunting. "Ghosts in the nursery"—unresolved childhood feelings, conflicts, and traumatic experiences—may compromise the adult's empathic responsiveness; the infant's signals of distress or bids for social interaction may elicit emotion-laden memories of the parent's own suffering and helplessness (Fraiberg et al. 1975). As a result, the baby's cries may be misinterpreted or remain essentially unheard; under circumstances wherein the infant's natural feelings and self-expression are rebuffed or ignored, a false self (Winnicott 1960) may develop as the child, rather than the parent, learns to accommodate the other's needs.

First Months of Life, Parent-Child Bonding, and Foundations of Self-Regulation

The body is the chief conduit for the infant's earliest mental experiences. Bodily pleasures and discomforts, along with the parent's holding and feeding, give rise to the baby's first internal representations (Fonagy and Target 2007). Preverbal infants signal their negative somatic states largely by fussing and crying; when contingent responses—that is, caretaking behaviors that closely correspond to the baby's signals—are consistently received, the parent's comforting presence and interventions are gradually internalized. As the first year of life proceeds, the infant's enhanced social and cognitive apparatus, along with the parent's reliable reactions, contribute to increasingly complex, organized representations of parent-child interactions. The result is a greater tolerance for momentary distress and a dawning capacity for self-regulation. Naturally occurring parental demonstrations of marked affect are particularly well-suited to infants' needs: these empathically attuned but slightly altered manifestations of infants' actual states (e.g., a playful, "mock" unhappy face) help babies internalize a modulated, less acute version of their own feelings (Gergely 2000); parents use playfulness routinely to manage their infants' states.

Beginning at 2-3 months with the emergence of social smiling, the infant enters a period of intense social interest and availability. Dyadic face-to-face exchanges with the parent bring tremendous pleasure and excitement to both; these affectively reciprocal interactions are comprised of continuous, largely unconscious processes of mutual self-regulating shifts and gestures (Beebe 2000). Young infants' sensitivity to their parents' interactive style is illustrated in the still face experiment, wherein mothers are instructed to engage in normal face-to-face behavior, followed by a "still-face" (i.e., an impassive, unresponsive expression). When confronted with a nonreactive parent, babies exhibit acute distress, frequently crying and averting their gazes (Tronick et al. 1978). The infant's internal representations of multiple caregiving and socialization experiences form the building blocks for internal working models (Bowlby 1969), mental depictions of self and other that will powerfully influence social and emotional functioning throughout the life span.

Hatching, Intersubjective Awareness, and Patterns of Attachment

By the middle of the first year of life, the infant begins to emerge from the parent-child "cocoon" and becomes increasingly aware of the world just beyond the dyad. Mahler refers to this as the process of hatching, wherein the baby begins to realize that the parent and the self are separate, differentiated individuals (Mahler 1972). Transitional objects—often soft, familiar items from the infant's immediate environment—and other transitional phenomena (such as bits of ritually repeated songs that the infant may invoke when alone) may provide comfort as the child copes with a novel sense of separateness and the subjective loss of parent-child intimacy (Winnicott 1960). The baby's growing interest in objects and active investigations of the physical world, enhanced by the parents' enthusiastic endorsement, are a critical source of learning: during the sensorimotor stage of intelligence, which extends from birth until 18 months of age, the child actively constructs information about the world via physical explorations and actions (Piaget and Inhelder 1969). Orality, the earliest modality of comfort and relief, is also a dominant method for the acquisition of knowledge; no object is spared reflexive mouthing by which the baby explores the world.

At 8-10 months of age, a momentous shift in the baby's social and emotional capacities becomes evident as he or she actively begins to seek shared mental experience with the parent. For the first time, the infant engages in joint attention, gazing back and forth from the mother's face to an object of mutual focus (e.g., a toy). An emerging propensity for social referencing, the deliberate soliciting and use of the parent's emotional state, is demonstrated in the visual cliff experiment: in this paradigm, crawling infants are placed upon an apparent visual drop-off; when their mothers smile and beckon, the children cross the "cliff," but when their mothers manifest fear or alarm, the babies refuse to move (Sorce and Emde 1981). This remarkable capacity to use the mother's expression as a guide serves as an extension of the attachment system into more complex, distal exchanges.

Such manifestations of the infant's enhanced social awareness, ability to seek adult feedback for affect regulation, and early forays into the world demonstrate the use of the parent as a beacon of orientation (Mahler and McDevitt 1982). Similar to attachment theory's notion of the secure base (Bowlby 1969), this term refers to the infant's highly visible use of the parent's bodily presence and facial expressions for security and exploration. The crawling or newly upright baby repeatedly ventures a short distance from the parent's side, examines toys, looks back to share pleasure and interest, and returns to the adult for emotional refueling. The infant's enhanced and specific awareness of the mother frequently leads to distress around separations and the arrival of strangers, known respectively as separation anxiety and stranger anxiety.

Ainsworth's seminal research on patterns of attachment examined the secure base behaviors in 12- to 18-month-old children in order to assess the quality of the mother-infant relationship (Ainsworth et al. 1978). In the widely replicated Strange Situation experiment, mother and child are observed in a laboratory playroom as they are exposed to a sequence of 3-minute events that stress the infant's sense of security. After a period of playing and acclimating to the new environment, the dyad is joined by a stranger (stranger anxiety). Then the mother departs (separation anxiety). The mother reenters and then both adults exit, leaving the baby briefly alone. When the mother returns to the baby, particular attention is paid to the quality of their reunion; this is considered the most potent indicator of the quality of attachment security.

The original Strange Situation research yielded three distinct types of attachment. Secure babies acclimate to the unfamiliar room and explore comfortably while the mother is near, evidence distress during separation, and are comforted by the parent's return. In contrast, avoidant children appear less connected, and their expression of emotionality is muted; they pay little overt attention to the mother's comings and goings despite somatic evidence of distress. Ambivalent,/Resistant babies manifest angry, upset, poorly regulated reactions: they are hard to settle even before the mother has left the room and fail to use her proximity for soothing and self-regulation. More recently, Main and Solomon (1990) identified children with disorganized/disoriented attachments whose inconsistent and incoherent reactions to separation indicated a particular vulnerability to poor self-regulation. These four relational patterns, established in the first year of life, have proved to be powerful predictors of lifelong trends and are highly correlated with the quality of attachment narratives in adulthood (Waters et al. 2000). For nonclinical middle-class samples, the proportions of attachment styles have been found to be fairly consistent and tend to fall in the following distribution: secure (62%), avoidant (15%), ambivalent/resistant (9%), and disorganized/disoriented (15%) (van Ijzendoorn et al. 1999).

Despite the depth and importance of the parent-child bond, the drive to achieve upright mobility soon begins to eclipse the older infant's preoccupation with the mother's presence. The pursuit of walking mastery creates a temporary imperviousness to minor bumps and mishaps; many babies, caught up in the intense practicing and excitement of locomotion, temporarily seem to lose sight of the parent. The achievement of this major motor milestone brings infancy to a close and ushers in the next developmental phase.

Table 5-2 lists the main tasks of infancy.

Toddlerhood, the Sense of Self, and Moral Development

Between the first and third birthdays, children's motoric and mental achievements transform their sense of self and relationship to the parents. The early months of the toddler phase are dominated by the recent mastery of walking: after a period of exhilaration, the child's mobility and enhanced self-knowledge fuel an increasing awareness of personal smallness and vulnerability. By the middle of the second year, the child has already begun to realize that the world is not "his oyster" (Mahler 1972, p. 494). Huge advances in language and emerging symbolic play enrich and expand the parent-child relationship but lessen the intense bodily closeness of infancy. Moreover, as parents sense their child's increasing capacities, they begin to impose limits and demands; expected standards of behavior are established via the powerful shaping influence of adult approval. The formation of superego precursors provides necessary structure for incipient autonomous self-regulation and bodily self-control.

Self-Awareness

As the baby enters the toddler period, he or she begins to acquire knowledge about the self as a separate, objective entity. Empirically, this major leap of self-awareness is illustrated via mirror self-recognition, a clever experiment wherein children are placed in front of a mirror after their noses are surreptitiously rouged; beginning at around 18 months, toddlers tend to smile and attempt to remove the marks from their own noses rather than merely pointing toward their reflections (Lewis and Brooks-Gunn 1979). At around the same point in development, self-referential play gestures (e.g., pretending to self-feed from an empty bowl) and language make an appearance.

The toddler's enhanced degree of self-awareness is accompanied by the emergence of self-conscious emotions, such as pride and shame. These novel emotional experiences, highly susceptible to parental demonstrations of love and approval or displeasure, are powerful motivators for learning and mastery. Importantly, maltreated toddlers evince self-recognition but manifest either neutral or negative affect when they encounter their reflections in the mirror (Schneider-Rosen and Cicchetti 1984); their lack of pleasure attests to the presence of self-feelings in this age group and suggests that these are deeply colored by the quality of the parent-child bond.

By around the age of 2 years, most children begin to acquire a gendered sense of self. They accurately label themselves as boy or girl; positive and negative self-feelings accrue to the toddler's notion of male and female. However, a full understanding of gender concepts—that is, of the link between one's sex and genitalia, the stability of one's sex, and the idiosyncratic but shared meanings of gender—is not grasped until several years later, toward the close of the oedipal phase (De Marneffe 1997). During the toddler years, children tend to associate a person's sex with tangible features, such as length of hair or manner of dress. One 2-and-a-half-year-old girl, after arriving at a play date and encountering her female friend's fresh short haircut, exclaimed to her mother, "Sarah's a boy!" Such concrete, preoperational thinking (Piaget and Inhelder 1969) and limited grasp of the permanence of sexual differences give rise to age-typical anxieties and envious feelings: for example, girls may express desire for a penis, and boys may exhibit concern over girls' "loss" of what feels to them like a fundamental bodily feature.

Rapprochement Crisis and Object Constancy

Junior toddlers' joyful absorption in walking and impervious attitude toward inevitable falls and minor mishaps soon yield to more sober realities. A physical ability to move farther from the parents and a growing awareness of the separate self give rise to a sense of personal smallness, powerlessness, and vulnerability. Such realizations often lead to an upsurge of separation anxiety and renewed efforts to reestablish the proximity of infancy. At the same time, the toddler is vigorously motivated toward autonomy, exploration, and mastery. These competing urges cause the child unfamiliar internal discomfort and confusion, often expressed via moodiness and tantrums; noting the toddler's intensified need for parental reassurance, Mahler referred to this period of relative negativity and contradictory behaviors (e.g., shadowing the parent and then darting away) as the rapprochement crisis (Mahler 1972).

The young child's distress and oppositionality—such as relentless use of the beloved word "no"—evoke strong reactions in parents, who then must manage their own aggression and frustration as well as the toddler's. Stable, empathic, and nonretaliatory parental responses are essential to support the child's growing tolerance of uncomfortable feelings and inner conflicts. The parents' capacity to reflect on the child's affective turmoil, label emotional experience, and refrain from angry responses helps the toddler modulate and integrate strong positive and negative affects. The gradual development of object constancy—a stable, internalized image of the self and others that is not vulnerable to shifting moods and situations—is a major accomplishment of early childhood. This extremely important intrapsychic capacity allows the child to retain an ongoing sense of the comforting parent even when in the throes of anger and aggressive outbursts and provides an essential foundation for autonomous self-regulation.

Superego Precursors, Internal Conflict, and Role of Toilet Training in Early Development

Beginning in the early years of childhood, morality is increasingly integrated into the child's sense of self (Kochanska et al. 2010). The toddler's enhanced symbolic capacities—language and playful imitation—are foundational for social learning. The parent's vocal praise and reproaches are progressively more meaningful, and mimicking parental behavior is a highly pleasurable activity. Moreover, the toddler's capacity for self-aware emotions and increased grasp of self-other boundaries and the novel pressure of parental discipline all contribute to the formation of superego precursors or internalizations of the parents' expectations and attitudes. Over time, these mental representations (known as introjects ) grow more stable, reliable, and organized; ultimately they allow the child to achieve an autonomous internal "moral compass" that does not require the physical presence of the parent.

The toddler's awareness of behavioral standards and of the potential to incur parental displeasure gives rise to new anxieties. The concern about parental proximity is supplanted by the toddler's worries about loss of the parent's love and approval; once the adult's expectations are known and internalized, the young child's opposing desires—for example, to touch forbidden objects, pinch a sibling, or urinate on the floor—create internal conflict. Although painful, the toddler's inner discomfort, dread of shaming, and fears of parental irritation powerfully motivate him or her toward better self-control and emotional self-regulation.

Toilet training represents a crucial juncture in the parent-child relationship, as the toddler begins the lengthy process of assuming bodily control and responsibility (Furman 1992). The child's alternating compliant, teasing, and withholding behaviors arouse strong parental emotions and may evoke the parent's own anal phase conflicts: wishes to mess, control, withhold and expel, and resist compliance. These conflicts revive in the parent's urgent wishes to restrain the toddler, untoward levels of anger, and extreme distaste for the child's "dirtiness." The combined presence of adult expectations and compassion for the toddler's struggles helps children gradually relinquish dirty pleasures, strengthen their awareness of inner and outer boundaries, and increasingly identify with parental standards of cleanliness and self-management. A central defense employed in this process is reaction formation, which turns a given affect or impulse into its opposite: the wish to mess is replaced by extreme fastidiousness and orderliness, and the wish to oppose is transformed into compliance.

Table 5-3 outlines the important tasks of the toddler phase.

Oedipal Phase, Its Significance in Development, and the Emerging Capacities of Early Childhood

Between 3 and 6 years of age, the child's inner and object relational life is transformed: a confluence of psychological, bodily, and familial factors gives rise to new mental structure as the world beyond the mother-child dyad is increasingly brought into awareness. Emotional complexity, born of the complicated force field of family love and rivalry and elaborated in the growing capacity to express the inner life in language and play, dominates the oedipal-age child's experience. By the time this developmental period draws to a close and the child enters the grade-school (latency) years, enduring self-fantasies, patterns of relating, and self-regulatory and self-monitoring capacities (superego elements) have begun to emerge.

Yet why identify this phase, generally called early childhood, by a term that may seem outmoded? We continue to think that there is value in Freud's original idea about human development and what he considered to be the most momentous period in early life. His reference to the timeless drama of intrafamilial conflict depicted in Sophocles' tragedy—neglect, abandonment, love, desire, hate, incest, parricide, shame, guilt, and reparations—highlights the intensity of emotion experienced by the oedipal-age child and adumbrates the profound impact this phase has on subsequent mental organization.

Although psychosexuality is by no means the sole force propelling oedipal development, the regular occurrence of an upsurge in sexual and aggressive drives, curiosity about parental intimacy and sexual relations, new emotions of jealousy and painful ambivalence, increased awareness of gender role identity and sexual orientation, and the emerging capacity to conform to social rules and experience shame and guilt repetitively cohere into a version of the oedipal narrative: desire for one parent and rivalry and hatred toward competitors, including the other parent and siblings. In our opinion, the regular appearance of these triangular force fields merits the continued use of this evocative terminology. The superego, that internal voice of conscience and moral standards, has been called the "heir of the Oedipus complex;" although its development begins much earlier, it predictably emerges as a coherent mental agency as this phase comes to a close, and it plays a key role in the transformation of the oedipal child into a more tractable and rule-observant school-age child.

Emerging Cognitive, Emotional, Social, and Self-Regulatory Capacities

Both psychodynamic and developmental theorists envision the years of early childhood as a foundational period of mental growth. An explosion of symbolic function, such as language and imaginary play, shifts concrete, perceptually bound thinking and communication toward increasing abstraction and complexity. The child's self-referential, egocentric viewpoint (Piaget and Inhelder 1969) is modified as distinctions between inner experience and outer reality become clearer, and the subjective mental states of others (i.e., private thoughts, feelings and intentions) are increasingly grasped (Fonagy and Target 1996). Together, these multiple developments vastly improve the child's capacity to express inner states, share meanings, engage in social collaboration, and regulate the typically unruly urges and conflicts of the oedipal phase.

Although the child's interpersonal world is expanding, the role of the mother-child relationship provides the groundwork for key psychological advances. Elaborative mother-child discourse encourages the preschooler to tell meaningful, embellished stories. Children with insecure attachments demonstrate inhibited pretend play and narrative incoherence (Lyons-Ruth 2006). Moreover, maternal use of mental state language (terms such as "think," "want," "hope") is linked to the child's development of social and emotional competence (Ruffman et al. 2002).

Language Development

The ability to narrate experience and share meaningful stories is a major development of early childhood. Autobiographical narratives and age-salient stories, such as where babies come from, acquire special significance. Moreover, young children become fiercely attached to beloved literature and fairy tales; these frequently feature oedipal themes and plots, often with more satisfactory conclusions than in real life. Desirous and aggressive feelings toward parents are safely displaced onto fictional love-objects and rivals; forbidden wishes are given free rein and then punished, via talion-style justice. Consider the classic fairy tale of Snow White, wherein a beautiful princess is envied and despised by her wicked, vain stepmother, the Queen. The queen attempts to kill the princess in multiple ways—abandonment, strangulation, and poison—and finally succeeds in putting her into a deep sleep. The spell is broken by Prince Charming's arrival and proposal of marriage. The evil queen is defeated and cruelly punished with a pair of red-hot iron shoes in which she is forced to dance at the princess's wedding. For the oedipal girl, this story provides ample satisfactions, including romantic love, jealousy, murderous feelings, retribution, and the triumph of the young girl over the mother-substitute. Boys are often drawn to tales of naïve heroes who prevail by slaying dragons (rather than fathers) and are rewarded by possession of their love-objects (usually a princess).

Theory of Mind

The acquisition of a theory of mind, or understanding of mental states, is a transformational process in development, usually demonstrable by the age of 4 years. Once children arrive at this cognitive-social-emotional turning point, they grasp the following: the difference between inner life and outer reality, the notion that people possess unique subjectivity, and the link between internal states and behavior (Fonagy and Target 1996). In the numerous studies that have investigated theory of mind development, false belief tests are often used to assess whether children can successfully discern another person's point of view and then predict behavior based upon that individual's knowledge.

The following is a typical false belief scenario: Jane is playing with a doll in the bedroom she shares with her sister, Eliza. She places the doll on her bed and leaves to go have a snack in the kitchen. While she is gone, her sister Eliza enters, plays briefly with the doll, places it in the toy chest, and leaves the room. When Jane returns to the bedroom, where will she look first for the doll: on the bed or in the toy chest? Typically, 3-year-olds have trouble with this task and tend to reach faulty conclusions: they assume that Jane knows what they know and respond that she will look in the chest. Four- and 5-year-olds answer correctly that Jane will look on the bed, because she has no knowledge of Eliza's activities; moreover, older children grasp a fundamental principle of mental state knowledge—that is, that people's private beliefs, even when false, nonetheless guide their behavior.

The ability to discern others' perspectives and see connections between mental states and behavior brings new meaning to the child's interpersonal world; one's own and others' actions seem more predictable and less random or confusing. Not surprisingly, mental state knowledge is correlated with essential developmental capacities, such as self-reflection, emotional self-regulation, and social competence (Denham et al. 2003). At the same time, an enhanced awareness of others' inner lives exposes the child to new vulnerabilities, such as the dawning realization of the parents' private relationship and a keener sense of exclusion. The painful notion that others may withhold confidential thoughts and feelings or that peers may share bonds and play dates from which one is excluded enters the oedipal child's consciousness for the first time and becomes part of enduring psychological experience.

Imagination and Play

Pretend play is a natural, growth-promoting developmental capacity that provides a window into the child's inner life. Vygotsky (1978) noted that in play, "the child is always behaving beyond his age": narrative building, dialogue creation, social perspective taking, and elaborate planning are in evidence as the child acts out deeply satisfying imaginary roles and plots. Moreover, by age 4 or 5 years, social fantasy play is a core feature of peer relationships, encouraging the need to collaborate, verbally share intentions, and incorporate others' ideas and desires (Howe et al. 2005).

In addition to providing the opportunity to practice emerging cognitive and social skills, imaginary play provides a safe, nonconsequential outlet for the increased sexual and aggressive urges that are part and parcel of the oedipal phase. Both narrative building and play facilitate the organization and expression of intense affects and help the child achieve mastery over impulses (Knight 2003). By attaching feelings and wishes to stories and playing them out, the child's inner experience is modulated: conflicts, anxieties, and impulses are elaborated, tempered, and then reintegrated. For example, the child who longs for adult roles and glorified romantic relationships is temporarily assuaged while playing mother or father, princess or superhero. For an illustration of imaginary play with oedipal themes, readers are referred to the video segment "Four-year-old girl" that accompanies Chapter 4 in our book Normal Child and Adolescent Development: A Psychodynamic Primer (Gilmore and Meersand 2014).

Imaginary companions are a commonly observed phenomenon that begins during the oedipal years; a survey of children 5-12 years of age reported that 46% of children acknowledged an imaginary companion currently or in the past (Pearson et al. 2001). These invented creatures often serve as the repository of the child's unwanted impulses while providing their creators with a sense of control and power. For example, a preschooler wrestling with self-control and fears of bodily injury may find consolation in a friendly, domesticated, but nonetheless invincible lion or tiger that requires frequent admonishments and behavioral restrictions. Interestingly, children with access to this imaginary vehicle show richer narratives and greater communication skills. As is true with the transitional objects of infancy, parents instinctively tend to tolerate the companion's existence and refrain from challenging its basis in reality.

Emerging Capacities and Emotional Life

From a modern psychodynamic development point of view, the oedipal complex must be understood as a product of the interaction of multiple development strands occurring within a family system. Major components include the emerging capacities described earlier as well as the shift in the child's bodily focus toward the genitals. Increased sexual arousal and curiosity, expressions of aggression, and the growing capacity to regulate behavior interact with parental reactions and the family situation. Expanded interpersonal relations, including both parents and siblings, foment a proliferation of new or amplified emotions: love, desire, rivalry, hate, humiliation, and guilt. These elements are organized into recurrent but individualized oedipal configurations that structure the child's experience.

The variations of the oedipal configuration are infinite. It is nonetheless usually possible to recognize components of the classical "positive" configuration—the child's longings for the opposite-sex parent (daughter for father, son for mother) and rivalry with the same-sex parent—as well as elements of the so-called negative oedipal complex (son longing for father, daughter for mother; rivalry with the opposite-sex parent). Complications ensue from within the child (including prior development, constitutional endowment, environmental nutriment, and their interactions) and from current environmental factors (such as parental dynamics, divorce, adoption, sibling cohort, and so on). Thus, although everyone's oedipal constellation has similar elements—interpersonal triangles, competition and rivalry, elements of primal scene imagery (the child as onlooker to an exciting spectacle of parental union)—each one is unique. Some children focus their rivalry on the "new baby," whereas others might struggle with the conviction that their hostility toward one parent resulted in the parents' divorce.

Passage through the oedipal phase inevitably shapes the organization of development going forward despite infinite variability, new elements, and unpredictable impingements from the environment. There is no prescribed "normal" passage through this phase. Furthermore, it is clear that the origins of self-regulation are traceable all the way back to infancy, when the mother-infant interaction gradually inducts the infant's behavioral control and self-regulatory capacities (Blum and Blum 1990; Sheikh and Janoff-Bul-man 2010). The coalescence of superego precursors into the relatively coherent mental agency that emerges toward the end of the oedipal phase requires contributions from a range of other developing systems, including receptive and expressive language, affect elaboration and affect tolerance, new defenses such as internalization, reaction formation and identification with the aggressor, the new capacity to mentalize, and a new cognitive organization of preoperational thinking. These developments all contribute to the relatively stable and coherent organization of superego activities, primarily direction giving, limiting, and punishing/rewarding functions. Although the superego evolves throughout development and is notoriously subject to corruption and inconsistency, its future shape is deeply imprinted by the end of the oedipal phase.

From an ego psychological^point of view, the confluence of developmental strands that compose the oedipal complex is perhaps most noteworthy for its enduring impact on personality. The conflictual constellation or template of triadic relationships reverberates in the object-relational patterns of the developing child into adolescence and adulthood and contributes narrative content to masturbatory fantasies. Future sexual arousal, desire, competitive strivings, rivalries, tolerance of ambivalence, sensitivity to narcissistic mortification, and revenge motives are all affected by passage through this phase. It is for this reason that the oedipal phase is seen as a watershed in development in terms of defenses, anxiety tolerance, object relations, sublimatory channels, impulse control, and nature of superego integration; pre-oedipal implies poor anxiety tolerance, reliance on splitting as a predominant defense, superego pathology, and impulsivity.

The developmental literature has offered multiple supportive correlations for the updated oedipal drama. Children consolidate the connection between genital and biological sex at around 3 years (De Marneffe 1997), so that the emergence of genital anxieties corresponds to the new appreciation of their differences. Despite this correlation, young children do creatively imagine that anatomy is fluid for some time afterward, supporting the notion of bisexuality (Senet 2004). Children's sexual and aggressive behaviors peak at roughly age 5 years (Friedrich et al. 1998; Mayes and Cohen 1993) and then recede. The observed quiescence in the child's overt expression of impulses as he or she moves into latency corresponds to the emergence of self-control and the efficacy of parental moral education. Emotional complexity and moral reasoning, linked to acquisition of theory of mind, show a demonstrable increase from 4 to 6 years of age (Eisenberg-Berg and Roth 1980); similarly, theory of mind and emotional understanding facilitate awareness of others' psychological needs and the motivation to adhere to socially acceptable behaviors as children approach age 6 (Lane et al. 2010). As we shall see, the superego of early latency is relatively rigid and unbending; indeed, the superego requires the whole sweep of development to assume its mature form.

Table 5-4 contains a précis of the important accomplishments of the oedipal phase.

Latency Years and the Shift Toward Autonomy

During the grade-school years, roughly between ages 6 and 10 years, children's enormous gains in cognition and self-regulation allow them to move well beyond the familial circle and invest increasingly in the world of peers and learning. The latency child's industrious demeanor, cooperative attitudes, and capacity to absorb vast quantities of knowledge and skills are universally recognized. Originally, Freud (1905/1962) applied the term latency to this phase, bookended by the more turbulent oedipal and adolescent periods, in order to capture the relative dormancy of the child's sexual and aggressive urges. However, current thinking about latency acknowledges children's ongoing struggles with management of impulses and emotions and their vivid fantasy lives, even while documenting the achievement of momentous intellectual advances.

Central Role of Learning In the Latency Child's Life

During a normal day, the latency child is confronted with a dazzling array of developmental tasks and expectations: multiple academic and extracurricular skills are assimilated, practiced, and mastered under the scrutiny of adults and peers. After the typically unstructured and nonevaluative atmosphere of preschool and kindergarten, the grade-school experience veers sharply toward specific assignments and relentless assessment. Learning and accruing skills play an increasingly central role in the child's self-concept; slow acquisition of basic academics or poor athletic proficiency pose substantial threats to the child's ongoing sense of pride, mastery, and competence.

When learning, both in and out of the classroom, is compromised as a result of innate cognitive or visual-motor weaknesses, the development of certain latency-phase defensive resources—for example, sublimation (the transformation of socially unacceptable impulses and feelings into structured activities such as academics and competitive sports) and intellectualization (the avoidance of intense feelings by a retreat to logic and rationality)—is also impeded. The redirection of the child's urges and affects into the beloved activities of grade-school children, such as school-based projects, sports, collecting, and other hobbies, is greatly strengthened during the elementary years by environmental opportunities. These sublimatory channels help in the gradual attainment of emotional self-regulation; for example, the oedipal child's avid curiosity about bodies and sexuality is usefully converted into the grade-school student's intellectual inquisitiveness, scientific researches, and fact gathering. The common presence of language-based or attentional weakness not only affects learning and self-regulation but also contributes to difficulty with the absorption and internalization of behavioral standards, interferes with self-monitoring and self-control, impairs socialization, and subjects the child to external and internal overstimulation.

The Phases of Latency

Early Phase: Cognitive Reorganization and the Child's Struggle for Self-Regulation

Between the ages of 6 and 8 years, the child's psychological functioning is dominated by recently acquired superego capacities: emotional self-regulation and behavioral self-control are fragile and easily disturbed by challenging circumstances. Although a "good citizen" deportment and growing capacity for sublimation are fundamental to the latency experience, the early elementary years remain somewhat tumultuous. Protests about perceived unfairness, tears about the difficulties of homework, or meltdowns over losing a board game are common manifestations. Such vulnerabilities of self-management contribute to the young child's rigid insistence on rules and to keen scrutiny of others' minor transgressions; tattling, a source of pleasure and self-reassurance, is common in this age group. Rules are not necessarily applied to the self: one 7-year-old girl who complained bitterly about her older sister's casual attitude toward the instructions for a particular game manifested little remorse over her own rather audacious cheating.

The child's entry into the cognitive period of concrete operations (Piaget and Inhelder 1969) at around the age of 7 years brings an increasing orientation to the reality-based world. Time and money concepts are mastered; collecting, sorting, and classifying materials are favored activities. More organized, coherent mental structures allow for internal, rather than action-oriented, problem solving; this momentous change has huge implications for the child's capacity to substitute thought for behavior and avoid impulsive reactions. Thinking becomes more logical, and the child is less likely to be deceived by the appearance of things; the process of decentering—that is, the shift away from highly subjective, egocentric thinking toward awareness of multiple perspectives—makes it possible to engage in abstract reasoning. This trend is beautifully illustrated by Piaget's Tests of Conservation, a series of experiments assessing children's ability to think beyond highly conspicuous physical features. For example, a child observes as water is poured from one beaker into a second with a notably wider shape; a researcher then queries the youngster about the quantity of liquid. The preoperational child, highly influenced by the beaker's concrete form, insists that the second beaker contains more liquid "because it is wider"; the concrete operational youngster, however, grasps that the volume of water is unchanged despite appearances.

Despite these myriad advances, the child's capacity for complex moral and social reasoning remains somewhat limited. The 6- or 7-year-old tends toward concrete, categorical judgments: behavior is good or bad, nice or mean. Notions about gender roles and characteristics are often rigid and highly conventional. Inward reflection is often avoided; internal discomfort and conflict are often externalized, and environmental rather than interior solutions are often sought. For example, when painful feelings of guilt arise, children may elicit parental punishment via misbehaving in order to re-externalize the critical voice of conscience. Although the early latency child's capacity for autonomy is expanding, key motivators for prosocial behavior remain tied to important adults; concern over parental or teacher disapproval and punishment, rather than appreciation for mutual regard and reciprocity, continue to guide the child's social thinking and reactions.

Later Phase: Use of Fantasy and the Increasing Importance of the Peer Group

The 8- to 10-year-old child is increasingly self-reliant. A confluence of enhanced self-control, smoother superego functioning, easier grasp of others' mental perspectives, more flexible social-emotional reasoning, and better planning capacities allows the older latency child to participate fully in complex peer interactions and rule-bound activities, such as group sports and clubs. Friendships and group memberships help children grapple with the sense of internal separation and loneliness that accompanies their greater autonomy and diminished dependence on the parents. The family romance, a universal latency fantasy, further compensates for the gradual de-idealization of parental figures and provides a safe outlet for the child's accompanying sense of loss and disappointment. The core of such fantasies, immortalized in well-known fiction such as the Superman story, is the theme of adoption: the child was "actually" born of royal or otherwise extraordinary lineage only to be separated at birth and then raised by the real-life, ordinary parents. Eventually, the special powers or status of the birthright will be restored.

Latency peer relations are foundational for a sense of companionship and belonging and for adolescent social, emotional, and behavioral adjustment (Pedersen et al. 2007). Those children who demonstrate a consistent capacity for emotional self-regulation and self-control are likely to enjoy good social adjustment in the grade-school years (Eisenberg et al. 1996). A substantial proportion of the child's social experience is conducted within same-sex groups, wherein gender identifications and roles are further reinforced and consolidated; as intimacy with the parents diminishes, membership in these groups provides an increasingly important source of social learning and self-esteem. Boys' groups tend toward exclusionary and competitive attitudes as well as hierarchical organizations; girls' groups are often somewhat more tolerant and less stratified (Friedman and Downey 2008). For examples of the thinking and socializing of normally developing latency-age children, readers are referred to the three video segments of latency-age children (a 7-year-old boy, a 7-year-old girl, and two 10-year-old boys interviewed together) that accompany Chapter 6 in our book Normal Child and Adolescent Development: A Psychodynamic Primer (Gilmore and Meersand 2014).

Table 5-5 summarizes the tasks and challenges of the latency years.

The Preadolescent and Adolescent Period

Adolescence became a legitimate development phase only at the turn of the twentieth century and was viewed as a cultural invention well into the 1950s. Today, developmental thinkers view the years between age 11 and age 22 or 23 years as a rich period of transformation—of body, brain, cognition, interpersonal relationships, and emotional life—consisting of a preamble (preadolescence) and three phases—early, middle, and late—although the boundaries of these epochs vary both within the developmental literature and among teenagers themselves.

Although prodromal bodily changes may feel vague, they also feel portentous as preteens contemplate the future transformation with excitement and anxiety. The onset of puberty, depending-Pn definition, is usually clear: menarche and first nocturnal emission are commonly chosen as the definitive moments and assume major significance for the child. Of course, the timing and subsequent pace and pattern of sexual development vary depending on many factors, including nutrition, genetics, socioeconomic class, and society. These variations in the pace of development are very much on the mind of adolescents, but both they and the adults around them are keenly aware of the inevitable: this momentous decade will take them from obedient childhood, in which parents both rule and protect them, to the autonomous status of adulthood (or emerging adulthood) and a strong sense of personal identity, a sexual life, self-determined values, and professional aspirations. Along the way, teens must renegotiate their relationship to parents, grapple with a peer group of growing importance, integrate their sexual bodies and desires into their self-representations, and consolidate their identities, moral codes, and life goals.

The pioneer of adolescence, G. Stanley Hall (1904), was the first to use the phrase "storm and stress" to characterize the disruption that he suggested was an intrinsic part of adolescent experience. As adolescence became the focus of developmental interest, the notion of adolescent turmoil was taken up and developed by such important thinkers as Anna Freud (1958) and Peter Bios (1967), who emphasized the inevitability of developmental disturbance during this phase. Simultaneous with their contributions, Daniel Offer (1967) provided a contrasting view based on surveys of nonclinical populations, insisting that the average adolescent did not experience major upheaval. Today most adolescent scholars take a middle ground. They describe adolescence as a vulnerable period, due to the confluence of rapid growth and shifting psychosocial demands, where developmental conflict, risky behavior, and moodiness are common (Arnett 2000) and family relationships must be reconfigured (Granic et al. 2003).

Adolescence is undeniably a time of transformation, posing an array of challenges to the teenager and family. Compounding the demand to integrate the radically changed body into the self-representation, the brain of the adolescent is also transforming. The adolescent brain undergoes massive synaptic pruning and proliferation of axonal connections, creating a leaner, more efficient organ (Hagmann et al. 2010); this process unfortunately creates the potential for markedly asynchronous progression of impulses and sensation-seeking on the one hand and inhibitory controls on the other (Dahl 2004). This neurobiological observation is often invoked to explain the uptick in risky behaviors in this age group, a finding that is clearly the result of many interacting systems. From a psychological perspective, this asynchrony correlates with renunciation of the internalized parental voice before the teenager is capable of consistent and self-determined measured behavior. Remarkably, there is a 200% jump in morbidity and mortality "due to difficulties in the control of behavior and emotion" of the adolescent (Dahl 2004, p. 3) compared with the grade-school child. These difficulties are manifested in alarming and even life-threatening acts, including substance abuse, carrying weapons, driving while intoxicated, unsafe sex, and suicide attempts. Some such behaviors can be understood as counterphobic flights into death-defying action as teens become increasingly conscious of their own urges and their mortality while rebelling against parental restraint. The action orientation is a disavowal of passive wishes to regress as well as an urge to aggressively define the self in the adult world. In addition, adolescence is distinguished from earlier childhood by the onset of many serious psychiatric disorders, including eating disorders, personality disorders, and psychotic illnesses.

Preadolescence

During this brief but critical phase, roughly between the ages of 10 and 12, the latency period is brought to a close and children begin to experience the mental and physical transformations of pre-puberty. The calm, industrious, and cooperative stance of the grade-school youngster shifts toward internal discomfort and outward restlessness as the body asserts itself via an uptick in sexual urges and emerging secondary sexual characteristics. Sexual feelings and bodily preoccupations, in the context of familiar parent-child closeness, are disconcerting for the preadolescent; an urgent push toward independence, a rejection of infantile ties and dependency, and a powerful turn to the peer group propel the child out into the world beyond the family. A sense of loss of control and fears about the potential, unknowable outcomes of growth spurts, weight gains, and changing physical contours disrupt the latency child's recently acquired self-regulatory capacities and feelings of pride and mastery. The preadolescent looks and feels awkward; the physical self is unfamiliar and strange and poses multiple opportunities for shame and exposure. Moreover, the inexorable masculinization or feminization of the body forces the child to renounce fantasies about limitless choices and possibilities and confront the realities of the bodily self. Under the pressure of physical, psychological, and familial changes, children tend to regress, and earlier phases of development are revived: boys' increased affinity for off-color jokes and scatological humor and girls' growing preoccupations with food and dieting are familiar manifestations (Bios 1958).

During preadolescence, the mother's auxiliary ego functions—her empathic mirroring, affect modulation, and support for the child's self-regulation—are unavailable for the first time in the child's experience; the preteen's mounting sexual and aggressive urges must be managed without maternal guidance and constraints (Fonagy 2008). Parent-child conflicts are common as the adults' authority and the parent-child roles are reorganized and renegotiated; in particular, mother-daughter relations suffer deterioration (Laursen et al. 2010). Such changes are often experienced by parents as sudden and bewildering; they are unprepared for the dissolution of previously intimate and harmonious bonds. Increased efforts to restore closeness may only lead to further rejections as the child veers sharply toward the world of peer socialization.

Attachment to gangs, posses, and cliques and the intimacy of the "best friend" relationship help mitigate the preadolescent's sense of separation and loneliness as the parent-child bonds are loosened (Knight 2005). Social acceptance and popularity gain importance; the peer group increasingly functions as a source of self-esteem, companionship, and security. Not surprisingly, social connectedness in late childhood is highly correlated with overall psychological and behavioral adjustment during the adolescent years (Bagwell et al. 2000). In contrast to the latency child, who pursues playmates with similar tastes in games and activities, the preadolescent increasingly focuses on intangible psychological qualities and seeks companions who can provide mutuality and reciprocal validation (Auerbach and Blatt 1996). However, although preteen bonds appear intense, they are simultaneously superficial and mercurial: often apparently close friendships are soon dissolved, and new identifications are rapidly substituted for previous ones. Such rampant experimentation with roles and identifications is reminiscent of the younger child's pretense and role-playing (Fischer 1991).

Table 5-6 lists the developmental tasks of preadolescence.

Adolescence Proper

Three major intrapsychic developments are central to the adolescent experience: integration of the sexual self and romantic longings into the self-representation, the second individuation (Bios 1967), and the identity crisis (Erikson 1968). As might be expected at this stage in the life cycle, these psychological processes extend and deepen the dynamic, mutually interactive interface between inner (mental) life and outer life—that is, the self as experienced and presented to the world and the world that responds to it. Sexuality, gender identity, romantic love, individuation, and resolution of the adolescent identity crisis rely on new relationships, require new opportunities for growth, and are deeply shaped by the nature of the environmental context, demands, and responses. These processes are connected to each other as well, because stable romantic relationships support adolescent identity and capacity for emotional expressiveness (Giordano 2003). Similarly, individuation is an essential platform for successful identity formation and permits the integration of the sexual self outside the parental orbit.

The Sexual Body

The task of integrating and coming to terms with the emerging sexual body, masturbation fantasies, sexual desire, and longings for intimacy occupies much of the early to mid-adolescent's mental life, usually culminating in the experience of a consummated love relationship in mid-to late adolescence; first intercourse usually occurs between ages 16 and 18 for girls and between ages 17 and 19 for boys (Pederson et al. 2003). The challenge of accepting and taking responsibility for the newly and irrevocably sexed body is woven into the contemporaneous awakening of sexual feelings and romantic longings. Individual conceptualizations of gender, a psychological construct with conscious and unconscious roots, are powerfully influenced by family and culture as well as by intrapsychic dynamics. The peer group continues to loom large as the important arbiter of what it means to be a young woman or man; of course, it also provides the outlet for sexual desires and fantasies. Romantic relationships accrue throughout the adolescent phases: one recent study reported that the percentage of teens describing "special" relationships in the past 18 months grew from 36% at age 13 to 70% by age 17 (Giordano 2003) and another documented that such relationships lasted for 11 months or more in 20% of 14-year-olds' attachments, increasing to 60% of the relationships of 17- to 18-year-olds (Collins 2003). Depending on their positive and supportive qualities, such intimate relationships can serve to facilitate the accomplishment of adolescent tasks, such as individuation and identity formation. Even the notorious "hook-ups" of today's youth culture, on closer examination, seem to be occurring more frequently among known and repeating partners, and one-third of these occur in the context of wishes for a more committed relationship (Manning et al. 2006). Indeed, today's youth is delaying first sexual intercourse compared to the teens of the 1990s (Guttmacher Institute 2012).

In the context of teenage sex, love, and romance, the use of social media has served an increasingly important function, arousing considerable controversy in the older generation. Parents and researchers alike seem to fall into "booster" or "detractor" camps. We concur with the sanguine view that teens will quickly and inevitably move into a "mediated world" that is vital for socialization; indeed by 2008, 93% of adolescents ages 12-17 were online and spent more time engaged with media than any other activity (Pascoe 2011, p. 7). The daily life of teens revolves around cell phones, social networks, blogging sites, and instant messaging; the majority of these communications concern logistics, love, attraction, and sex. Indeed, as sex education in schools has diminished and become increasingly negative toward expressed sexuality, adolescents rely on the Internet for information as well as for a means to express interest and desire. Certainly the Internet can provide sanctuary for troubled teens who are unable to accept their bodily selves, but despite the "moral panic" in adults who fear the corrupting and dangerous impact on their children and students, the majority of online activities take place among familiar peers and for the purposes of sustaining intimacy and communication. Although sometimes in violation of parental prohibitions, these interactions are mostly safe; the possibility of predators and bullying is comparable with that of off-line aggression. Savvy teens know how to navigate and what to avoid; unfortunately, disadvantaged teens lack the financial resources to avail themselves of this important portal to information and contact (Pascoe 2011).

The Second individuation

The second individuation (Bios 1967), beginning in the preadolescent phase, refers to the young teenager's growing need to reconfigure and renegotiate his or her relationship to parents in order to establish a sense of autonomous identity and self-responsibility and to achieve "object removal"—in effect, a shift in the focus from the primary objects of childhood (mother and father) toward appropriate nonincestuous objects. This process does not require overt "storms," although some conflict with parents usually punctuates the adolescent process, peaking during middle adolescence (de Goede et al. 2009). In Bios' formulation, the process is ideally neither fraught with conflict nor hinged on a physical separation or rejection of parental supports and values (Bios 1967). However, psychological regression (as the teen grapples with the threat of sexual impulses and the demands of greater responsibility) can result in occasional "violent ruptures": the adolescent attempts to avoid the backward pull toward childish dependency by battling with parents. For example, a teenage girl's disgusted rejection of everything about her professional mother—her style, her career, and her personal values—and simultaneous idealization of a notorious drug-abusing and sexually audacious celebrity can be understood as a regressive attempt to disengage from the mother by a childish, contrarian idealization. That same girl's sudden leap into mature and responsible functioning as a peer mediator in middle school reflects the ebb and flow of forward movement, as she asserts a reasonable moral code and negotiates with a sensitive awareness of multiple perspectives.

Identity Crisis

Identity formation is a lifelong process that begins in infancy and extends into adulthood; it is a life crisis (Erikson 1968) in adolescence, as the teen moves out of the parental sphere and creates an autonomous self. Many facets of core identity coalesce in adolescence, both conscious and unconscious. Sexual identity, sexual object choice, and gender role identity are adolescent-specific components of identity formation, rising to the foreground for most teenagers as they come to terms with their sexuality. Race, ethnicity, political beliefs, religion, dietary regulations—any and all of these can become more or less prominent features of the individual's conscious sense of self; often this depends on the contemporary social climate. Yet the process of identity formation also has roots in unconscious identifications that begin early in life; the identity crisis involves the reworking, including the repudiation, of some of these as the adolescent gradually discovers and consolidates the sense of "self in the world," with unique goals, values, and psychologically defining features differentiated from those of the family of origin and family culture. In contemporary Western society, the adolescent is offered a psychosocial moratorium (i.e., the college experience) as a way station to explore various identities and identifications, to seek self-selected models, and to ponder how to give meaning to life. Nonetheless, the identity process typically encompasses the whole sweep of adolescent development. Indeed, scholars interested in the decade between ages 20 and 30 years (called emerging adulthood ) suggest that the identity crisis actively extends into the twenties.

In the discussion that follows, we define early adolescence as the years between age 11 or 12 and age 14 (overlapping preadolescence due to variable onset of puberty), middle adolescence as between age 14 or 15 and age 18, and late adolescence as between age 18 and age 22 or 23. These divisions correspond roughly to the academic sequence in the Unites States, namely middle school or junior high, high school, and college; unfortunately, school changes can become yet another stressor in the "pile up" of transformation (Giordano 2003). As noted, each child traverses the second decade of life at his or her idiosyncratic tempo, grappling with development tasks in unique ways; differences in pace and approach can create a sense of discordance within the self or in relation to the peer group.

Early Adolescence (Age 11 or 12 Through Age 14 Years), Middle School, and the Body

The preteen and young adolescent experience is fraught with transformation; for most pubertal children, the changes in their bodies are their primary focus. Beginning with the prepubertal growth spurt, the pace of change in terms of height, weight, and development of secondary sexual characteristics rivals the growth rate in infancy but occurs in a young person who is intensely focused on the process. Self-consciousness, often with a negative valence, is a common feature of early adolescence.

Beginning in the preteen period, the child's enhanced social and intellectual capacities include an increased awareness of others' opinions and a greater tendency to incorporate external evaluations into the self-concept; these lead to heightened self-scrutiny, anxious concerns about bodily appearance and personal attractiveness, a sharper sense of individual status and popularity, and all-round harsher self-appraisals (Molloy et al. 2011). Delayed or precocious puberty is likely to be accompanied by great shame and self-consciousness and fears of being perceived by the all-important peer group as outside of the mainstream. Unusually early maturity and rapid rate of pubertal change have been linked to a variety of psychological risk factors, including depression and decline in the quality of peer relationships (Mendle et al. 2011). Moreover, parents' reactions to their child's maturing body run deep: evoked memories of their own pubertal awkwardness and unhappiness, a painful sense of loss of their formerly innocent and obedient child, and discomfort with their preadolescent's emerging sexuality may cause adults to withdraw.

The construct of the "imaginary audience" (Sebastian et al. 2008) was developed to operationalize the observation that young adolescents are preoccupied with how they appear to others. The imaginary audience is a byproduct of the egocentrism of early adolescence that accompanies the shift in cognitive capacities to formal operations (Piaget and Inhelder 1969; Ryan and Kuczkowski 1994)—that is, higher-level abstract thinking and hypothetico-deductive reasoning. As teenagers transition into the more developed capacity to mentalize and consider others' perspectives, they seem stuck on how these diverse viewpoints apply to themselves (Elkind 1996). It is as though the newly developed ability to think about other people's minds contributes to the conviction that others are "thinking only about you." The imaginary audience has also been connected to the process of individuation and identity formation (Sebastian et al. 2008).

Self-consciousness is, of course, linked to the bodily transformation that the young adolescent is only just beginning to learn about and understand. The teenager must manage the new demands of the sexually mature body, which include unfamiliar hygienic regimens; unprecedented "accidents" related to menses and nocturnal emissions; unexpected, often humiliating indications of arousal; and other manifestations of "raging hormones" (Dahl 2004). Beyond the daunting challenge of integrating the new requirements and features of the actual sexual body into the self-representation, the young adolescent must also grapple with sexual fantasies and desires that disrupt many established patterns of his or her emotional life. The desire to escape the physical self and renounce sexual and aggressive urges gives rise to novel defensive trends, such as intellectuality and asceticism (Sandler and Freud 1984). Seeking refuge in the life of the mind, through books, ideas, and cognitive pursuits of all kinds or by pursuing abstemious practices, such as dieting or vegetarianism, provides a sense of control over internal feelings and impulses. The use of technology, such as social media, further allows an imagined, temporary escape from the corporeal world. Moreover, baggy clothing and nongendered fashions can be employed in order to deny the increasingly defining features and contours of the preteen body.

In the context of these struggles, closeness to parents may suddenly feel too intimate. Similarly, the internalized family ethos, an important foundation of the superego, is shaken by the loosening of conscious and unconscious identifications that were so helpful for self-regulation in latency. This internal shift, even if not "stormy," affects mood and self-esteem as teenagers struggle to develop autonomy and find their own values. For example, the sense of self as a sexual person—and even more challenging, a specific kind of sexual person (e.g., someone who is turned on by a person of the same sex or by a person who is unacceptable to one's family culture)—can be disturbing and disorienting. Masturbation, which provides a mostly safe opportunity to explore these sexual feelings and fantasies, can feel shameful to a young teenager who has yet to feel entitled to a sexual life. Shame complicates the emergence of romantic feelings and the interest in others for sexual experimentation.

The culture of middle school is rigidly hierarchical, with a pecking order of cliques and crowds that typically affiliate around conventional similarities, such as academic performance and athleticism, and show intolerance of differences: "opposites detract" (Laursen et al. 2010). These exclusionary attitudes and cliques support the sense of identity and assuage the loneliness of young adolescents but also often result in bullying behavior. Studies over the past decade estimate that up to 30% of students report involvement in significant bullying, as either bully or victim, at some point in middle or early high school (Milson and Gallo 2006); in 2001 the American Medical Association reported 3.2 million children between sixth and tenth grades were victims of bullying. Bullying has been linked to prior difficulties in terms of self-esteem, parent-child relationships, experience of siblings, and so on (Sentse and Laird 2010). The young person's confidence and relative success in the school environment, the complex product of multiple developing systems, appear to be correlated with a more egalitarian home life where self-determination is tolerated (Yee and Flanagan 1985).

Psychiatric disorders, especially those related to bodily transformation, begin to emerge in early to middle adolescence under the combined influence of each child's endowment and prior history, anxieties and feelings of helplessness related to the rapidly changing body, the flood of media images, and current environmental pressures from family and especially the peer group. Although full-blown eating disorders are more commonly diagnosed in middle adolescence (Coelho et al. 2006), there is ample evidence that preoccupation with weight begins around puberty; 50% of girls report dieting between ages 11 and 13 and fully 80% of 13-year-olds, boys and girls alike, report they have tried to lose weight. Preoccupation with weight and diet has been linked to the young adolescent's struggle to control and come to terms with the rapidly transforming body and, in some cases, to postpone sexual maturation. Many dieters have subthreshold disorders that resolve over the course of adolescence. Contemporary surveys show that this problem is growing among boys, particularly those who were overweight in childhood.

Middle Adolescence (Age 14 or 15 Through Age18Years), High School, and Autonomy

Middle adolescence corresponds roughly to the high school years and encompasses many familiar features of adolescence as depicted in media and literature. These are teens motivated by a desire to experience the world, augmented by their new privileges and opportunities that allow unsupervised access. Allowances, cars, media input, Internet availability, opportunities for sexual experiences, and availability of illicit substances must all be navigated without adult guidance. Remarkably, adolescents negotiate all of these contemporary freedoms and temptations while simultaneously engaged in a highly competitive effort to succeed in high school and obtain entry to college. Focus on college shapes the high school experience of a majority of American youth, as documented by the noteworthy statistic from the Department of Labor's Bureau of Labor Statistics in 2012: 68.3% of the 2010 class of graduating seniors in the United States were attending college in 2011.

Middle adolescence is a peak conflictual moment in parent-child relationships as teenagers' increasing independence makes the task of knowing how and when to intervene, set limits, and guide behavior a tremendous challenge for parents (Collins and Laursen 2006). This tension corresponds to adolescents' ongoing intrapsychic process of disengaging from parental values and morals, which leaves them more susceptible to peer and media influences and more prone to risky behaviors, such as unprotected sex with multiple partners, substance abuse, use of weapons, reckless driving, and suicide. In regard to sex, there is some evidence to suggest that excessive media immersion, especially among white youth, can hasten sexual activity (Brown et al. 2007); on a psychological level, it appears that underlying deficits in emotional regulation of sad feelings is correlated to multiple sexual partners, suggesting that such behavior may be driven by an "attempt to fill the emotional void and sense of loneliness" (Hessler and Katz 2010, p. 245). Dysregulation of angry feelings is robustly associated with other risk behaviors, such as substance abuse and behavior problems. Problem behavior theory proposes a multisystem approach to risky behavior, including environment and intrapsychic and constitutional factors beginning in early childhood that are mediated by protective factors such as good models and availability of emotional supports (Jessor 1991; Schofield et al. 2008).

Mid-adolescents are relatively settled into their new bodies but still seeking to define their own version of masculinity and femininity; the meaning of gender and sexuality continues to evolve in the mix of gender- and sex-laden media messages targeted at this age group and the context of the particular subculture. At the same time, and perhaps contrary to expectations, a "mid-adolescence shift" has been described in regard to intimate relationships; teens ages 15-17 choose partners based on personal compatibility, as opposed to conventional status features (e.g., clothing, looks, or possessions [Collins 2003]) more typical of middle schoolers, and they use media to communicate and sustain meaningful relationships. As noted, the time of first intercourse, a notoriously unreliable statistic, seems to occur toward the end of high school, earlier in girls than in boys. Sexual intercourse is usually initiated with a romantic partner among teens (75%), but a high percentage (variably reported as 50%-60%) have had sex at some point with a non-romantic partner (Furman and Shaffer 2011). The latter finding has been recently contextualized to show that these "non-dating" sexual episodes are often repeating contacts in longstanding friendships in which at least one participant has hopes for a deeper commitment (Manning et al. 2006). For a sampling of the themes of middle adolescence, readers are referred to the video segment of a 15-year-old boy accompanying Chapter 8 in our book Normal Child. and Adolescent Development: A Psychodynamic Primer (Gilmore and Meersand 2014). This self-reflective 10th grader describes the gamut of typical mid-adolescent concerns: love, risky behavior, and family relationships.

Late Adolescence (Age 18 Through Age 22 or 23 Years), College/Employment, and the Consolidation of Personality

Late adolescence begins with the transition from home to college and marks a significant shift in adolescents' relationship to family and their sense of autonomy and self-determination. Beginning in the senior year of high school, particularly after college applications are in, there is increasing anticipation of college life, which portends release from parental supervision and the opportunity to make independent choices about the future. A remarkable transformation occurs in many seniors as they contemplate the end of their high school chapter; the rigidity of their social world begins to dissolve, interesting personalities and relationships emerge as cliques fragment in anticipation of separation, and more egalitarian relationships with teachers develop. These changes are often deeply enjoyed by the graduating senior who feels newly recognized as a unique freestanding individual and affirmed as a person with a future. Reverberating in mental life, such shifts ideally launch the identity exploration of the coming years.

As a result of the "college for all" mandate, the majority of graduating seniors attend college, be it the local community college or an Ivy League university (Rosenbaum 2011). The years of college provide the breathing room for the intrapsychic transformation into more coherent and defined personalities as young people explore identities, refine their interests, stabilize their defensive organization and sublimatory channels, and develop relatively smooth and consistently patterned functioning. Although physical development is minimal compared with the early phases of adolescence, there is a sense of maturation and a deepening and specialization of cognitive capacities as the choice of college major and employment opportunities begin to shape the vision of adulthood in the adolescent's mind.

The struggle for identity in college is never fully independent of prior identity formation, but the geographical and psychological remove provides a clarity and perspective on family culture and the older adolescent's identity within it. For some, entry into college can be rocky due to the dismantling of parental controls, revealing unreliable and immature self-regulation. The search for self-selected "new developmental objects" (i.e., adults available for idealization and identification) is guided in the college or employment setting by the young person's more conscious and deliberate interests and beliefs: the choice of a mentor facilitates the gradual revision of the superego that is the work of late adolescence. The grip of parental values diminishes as the older adolescent is exposed to a vastly expanded world; with this loosening, new identifications develop that are at least in part directed by self-selected interests and ideals. Of course, these identifications are both conscious and unconscious; the college student may actively strive to emulate an admired professor and, out of awareness, be deeply influenced by a charismatic roommate or the contemporary cultural climate. For example, shifting cultural valuations of social commitment versus financial success vary from generation to generation and seep into the mental life of adolescents, shaping their visions of the future.

As older adolescents develop deeper and more meaningful relationships, the self-in-relationships contributes to identity and sense of self. Falling in love, truly a universally occurring altered state with neurobiological underpinnings (Yovell 2008), is a developmental accomplishment that optimally both relies on and facilitates individuation from the family of origin and evolution of an identity. Indeed, the capacity for intimacy in late adolescence and emerging adulthood (see section that follows) seems correlated with both ego strength and relational identity assessed in middle adolescence (Beyers and Seiffige-Krenke 2010). This finding supports a multisystem view that recognizes that even an entity such as ego identity is composed of multiple "identity domains" and that the capacity for intimacy is a complex outcome of interacting developmental strands.

Readers are referred to the video segment of a 20-year-old that accompanies Chapter 9 in our book Normal Child and Adolescent Development: A Psychodynamic Primer (Gilmore and Meersand 2014). This young woman, who enjoyed a very close relationship with her family, is grappling with the conflict between autonomy and dependence.

Table 5-7 summarizes the tasks of the entire adolescent period.

Emerging Adulthood

A New Developmental Phase?

Just as adolescence was "discovered" in the twentieth century, so emerging adulthood has been in the twenty-first. James Arnett, who coined the term emerging adulthood, insisted that in our society the twenties are a time of significant developmental progressions, especially in view of the transformation of contemporary culture (Arnett 2000). The existence of this phase reflects a notable generational shift in terms of the achievement of adult markers. In twenty-first-century Western society, the typical markers of adulthood—the concrete accomplishments of independent living, marriage, starting a family, and career—have been postponed. For example, in 1960, 44% of male and 68% of female 25-year-olds had accomplished all of the traditional indicators of adulthood (employment, marriage, parenthood, financial independence), whereas in 2000, only 13% of males and 25% of females had done so (Furstenberg 2010). Arnett suggested that there are important intrapsychic accompaniments of this extended period of what might be called pre-adulthood.

Arnett proposed five criteria for this stage: identity explorations, instability, self-focus, feeling in-between, and a widening of possibilities. He emphasized the centrality of role exploration as "the heart of emerging adulthood" (Arnett 2000). It is his contention that in Western societies, the cognitive, emotional, and behavioral advances accompanying the twenties are sufficient to constitute a discrete developmental phase in its own right. For some thinkers this stretches the fundamental idea of development well beyond its roots in the quantum transformations of brain, mind, and body that drive the process forward. There are no reconfigurations, no transformations in terms of mental organization. Arnett's criteria would seem a continuation of adolescent tasks, complicated and prolonged by Western cultures as they are affected by technology and new social realities. It is argued by detractors that these twenty-somethings are not in their own developmental phase but rather living "divided lives"—simultaneously youth and adult—and that they are also "nowhere" because they cannot turn to established societal institutions to make the transition (Shulman et al. 2005, pp. 578-579). The structured pathways to adulthood that were available to their parents no longer exist in our society, and these emerging adults therefore cannot rely on adult guidance or time-honored cultural conduits to help them.

The State of Mind of Twenty-Somethings

The subjective state of this age group, as assessed in surveys and interviews, certainly documents the thematic concerns and sense of in-between that Arnett described: these young men and women feel neither teenager nor adult (Horowitz and Bromnick 2007). Although optimism has been reported in some surveys, there is often a sense of uneasiness and disillusionment with the promise of the future. The idea of emerging adulthood rests on the observation that the conflicts assigned to adolescents have a biphasic dimension. In this society, after a period of exploration in college, identity is extended, revisited, and resized for the adult world. Some risky behaviors actually peak in emerging adulthood, especially alcohol consumption (Arnett 2000). A new miniphase of instability, confusion, and self-focus requires that the young adult face crucial tasks and decisions central to adulthood: identity and individuation achieve their final form, intimate relationships become commitments, and career choices set the course for the future. Moreover, the solutions to developmental challenges introduced during this phase, whether adaptive or maladaptive, can have profound effects on the individual's future psychological adjustment (e.g., see Tucker et al. 2005).

As emerging adults often return to their childhood homes while searching for their futures, their individuation process in relationship to their parents takes on a new dimension. Standing on the threshold of adulthood, the young person has a new perspective on parents' values and on parents' interpretations of gender role. In addition, the emerging adult's perspective on love is colored by pride or disappointment in the parents' marital relationship. Finally, sibling relationships undergo revision, often for the better, as emerging adults definitively extricate themselves from their family positions and see their siblings more clearly.

Individuation is profoundly affected by contemporaneous social trends; young men and women must not only differentiate in relationship to their parents and family culture but also forge their way in the broader culture and social ethos. The opportunity for "role exploration," emphasized by Arnett, occurs under differing degrees of pressure to commit, emanating from cultural and family customs and expectations as well as personal goals.

Table 5-8 presents the key tasks of emerging adulthood. Readers are also referred to the video segments of 25- and 26-year-old men accompanying Chapter 10 in our book Normal Child and Adolescent Development: A Psychodynamic Primer (Gilmore and Meersand 2014). These young men describe their paths to adult identity, each through the unique lens of his psychology and history.

Key Clinical Points

• Development is the process that integrates endowment, emerging capacities, environment, and experience and results in nonlinear sequential mental organizations.
• Developmental tasks are the specific challenges to the mind emanating from environmental expectations and individual maturation and their interaction in personal experience.
• A psychodynamic approach to development considers subjective experience and narratives and privileges the role of the body, the interpersonal world, unconscious fantasy, and the pull toward the next level of mental organization.
• During the infancy period (ages 0-12 months) mental structure begins to form in the context of an ongoing dyadic relationship. Parental history and fantasies are crucial determinants of the baby's psychological development. The infant's shifting psychosomatic states, along with the parents' comforting presence and consistent care, are gradually internalized, leading to the formation of increasingly consolidated mental representations of self and other. Affective sharing and reciprocity are fundamental to the parent-infant bond; by the end of the first year, the dyad displays distinct styles of attachment.
• Toddlerhood (ages 1-3 years) commences with the baby's upright mobility, increased self-awareness, and' emerging sense of separateness from the parent. An inward drive toward independence and exploration conflicts with a newfound sense of vulnerability, leading to ambivalence and negative moods. The toddler's self-conscious emotions (shame and pride) and increased capacity for verbal communication facilitate the gradual internalization of parental standards and expectations, such as toilet training.
• The oedipal phase (ages 3-6 years) is a rich period of development with a range of emerging capacities: complex language and narrative creation, imaginary fantasy, symbolic play, and the child's acquisition of a theory of mind are among the most essential. Oedipal complex is a term used to designate the coalescence of the child's expanding object relations, emotions, and sexual and aggressive drives into recurrent triadic dramas involving the family: love, desire, rivalry, murderous aggression, and narcissistic mortification are all part of this tumultuous period. The advance of the superego, in addition to the development of other systems, facilitates the gradual quiescence and repression of this force field, although its impact is evident in personality development going forward.
• The latency phase (ages 6-10 years) is marked by the child's vastly increased availability for learning, enhanced self-regulation, and expanding social horizons. In early latency, the ongoing process of superego integration contributes to rigidity and fragile self-control; in the latter years, less concrete thinking and more reliable self-management facilitate a deeper immersion in the world of school, friendships, and group activities.
• Preadolescence is a brief but turbulent phase (ages 10-12 years) in which the child subjectively begins to experience the imminent psychological and bodily changes of puberty; these disrupt the calm, compliant attitude of the latency child and initiate a period of inner turmoil and regression.
• Adolescence is usually roughly divided into early (age 11 or 12 through age 14 years), middle (age 14 or 15 through age 18 years), and late (age 18 through age 22 or 23 years). Dramatic physical changes make the body the primary focus of young adolescents, and with that, sexuality, sexual identity, masturbation, and love pose associated challenges that extend into late adolescence. Renegotiation of family relationships is hastened by the emerging sexuality of the child, and the superego of latency is re-externalized in order to be reworked over the course of this entire period. Fighting with and distancing from parents (the overt part of the second individuation) augments the importance of peer group, which becomes a potent ‘‘invisible audience'' and measure of self-esteem as well as a vital opportunity for new relationships. The identity crisis comes to a head in late adolescence, fostered by the psychosocial moratorium provided by college.
• Emerging adulthood (22-30 years) is newly recognized (in Western cultures) as a developmental phase with its own challenges. Arguably the product of broad shifts from the twentieth century paths toward the familiar adult milestones of independent living, marriage, childbearing, child rearing, and stable career choice, emerging adulthood reflects the reality that intrapsychic identity work often continues post-college and that role exploration is an active part of the 20s.

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Suggested Readings

Fonagy P, Gergely G, Jurist E, et al: Affect Regulation, Mentalization, and the Development of the Self. New York, Other Press, 2000

Fraiberg SH: The Magic Years: Understanding and Handling the Problems of Early Childhood. New York, Scribner, 1996

Gilmore K, Meersand P: Normal Child and Adolescent Development: A Psychodynamic Primer. Washington, DC, American Psychiatric Publishing, 2013

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Sroufe LA, Egeland B, Carlson E, et al: The Development of the Person: The Minnesota Study of Risk and Adaptation From Birth to Adulthood. New York, Guilford, 2005

Recommended Novels

Kincaid J: Annie John. New York, Farrar Strauss & Giroux, 1997

McCullers C: The Member of the Wedding. Boston, MA, Houghton Mifflin, 1946

Mitchell D: Black Swan Green. New York, Random House, 2006

Salinger JD: Catcher in the Rye. New York, Little Brown, 1951