Cohen, Etty. Playing Hard at Life: a Relational Approach to Treating Multiply Traumatized Adolescents

Adolescence, Winter, 2004

COHEN, Etty. Playing Hard at Life: a Relational Approach to Treating Multiply Traumatized Adolescents. Hillsdale: the Analytic Press, 2003. 248pp. $45.00 (h).

Playing Hard at Life brings contemporary relational thinking to bear on the psychodynamic treatment of a notably difficult group of young patients: multiply traumatized adolescents, whose understandable hostility, resistance, even obstructiveness, render them poor candidates for treatment of any kind. Working with New York City teenagers who have survived the wars of inner city life and Israeli teenage soldiers who have survived the wars of the Middle East, author Etty Cohen documents the extraordinary challenges of forming a treatment alliance with these shattered youngsters, of engaging them psychodynamically, and of working toward a viable termination. The result is not only a poignant record of courage and commitment (on the part of patient and therapist alike), but also a valuable extension of modern trauma theory to adolescence as a developmental stage with its own challenges and requirements. The heart and strength of Cohen's book is her vivid documentation of hands-on encounters with her adolescent patients, seen both individually and in group. Cohen makes plain that, with young people so horrendously traumatized, treatment assumes a necessarily improvisational character. And yet, she argues, even in the type of pragmatic encounters dictated by massive and repeated trauma, contemporary relational theory provides a compass with which to navigate through the rocky shoals of the clinical work. Whether juxtaposing issues of disclosure with adolescents' love of secrets; drawing on the relational literature on enactment to comprehend more humanly the massive "acting out" of her patients; or invoking Ferenczi's distinction between "tenderness" and "passion" to chart the course of her group's transference engagement of her, Cohen is persuasive in showing how a relational approach enables productive therapy with this treatment-resistant population. Again and again, the reader is shocked by just how much happened to these adolescents, astonished at how resilient they proved to be, and, finally, moved by how much Cohen was able to accomplish with them.