Understanding Hard to Reach Adolescents: A Bio-Psycho-Social Model of Aetiology, Presentation and Intervention

This thesis examines hard to reach adolescents in respect of; the link between historical, contextual and familial factors, the young people’s inner working model and the manner of intervention with such young people and how one might understand what is most helpful.
Psycho-social case work with seven Black and Minority Ethnic (BME) adolescent boys in an area of high social deprivation and ethnographic study of the direct and wider environment was undertaken. This environment of trauma organised systems, within a community dominated by gang violence was impactful on the whole project.
The data was analysed by means of a case study approach using psychodynamic, attachment and neurodevelopmental paradigms. The findings suggest that early and ongoing adverse relational and attachment experiences impacts on four aspects of ‘hard to reachness’: Biological, Unconscious, Relational and Environmental. This includes neurochemical disregulation, excessive use of projective processes, emotional immaturity, difficulties with reciprocity and taking responsibility. The four aspects of ‘hard to reachness’ correspond to four domains of intervention: Management and Safety, Therapeutic, Relationship and Social/External. The relationship is seen as central to successful intervention and the worker needs to be able to move between domains as required.
Three groupings of presentations were identified; Chameleons, Reactors and Fragmentors based on neurodevelopmental arousal states, types of projective process and attachment styles. Reactors were seen to be typical of the hard to reach group. It is argued that the Reactors continue to rely on very early teleological or concrete behavioural defences which are interactive rather than interpsychic. Thus their behaviour is seen as immature, annoying and deliberate rather than archaic defences against anxiety where neither workers nor young people understand the powerful unconscious forces underlying their acting out.