Workingwithteenagersinaninpatienthospitalization.

A
systemiclookinnursingthoughtandpractice.
1

BletsosConstantinos

Summary

Systemic thinking has caused a revolutioninclinicalpractice,throughtheparadigmshift

(Kuhn, 2000), from the individual and internal medicine, in relationships and broader social
networks. The application of systemic belief in the working environment of Adolescent
Psychiatric Inpatient Care Unit (AICU) provided the opportunity for the fullestconsiderationof
the therapeuticreality,offeringinterestingcasesandreflectionsontheinteractionbetweenyoung
people and the health care team members. Alongside,thesystemicpracticeofferedthetoolsand
techniquesforthetheoreticalapplicationineverydayclinicalpractice.

PsychologistNurse.AdolescentInpatientCareUnit(AICU),DptofChildandAdolescent
Psychiatry,SismanogleioAmFlemingGeneralHospital,AthensGreece.
1

Introduction
According to the first order cybernetics, the patient/ therapist system is perceived as a
given objective, which can be studied, separated and manipulated. On the other hand second
order cybernetics perceives the relationship as an inseparable system, as a therapeutic process
the outcome of which depends on the quality of interaction (Heylighen, 2001). The concept of
autopoiesis, introducedbyMaturana&Varela(1987),providestheoperationalautonomyforthe
systems and therefore renders problematic the notion oftherapeuticguidance.Fromthemoment
that both the therapist and patient are perceived as subsystems of the undivided therapeutic
system, reductionist guidance / nonguiding separation is considered as a devoidessential.Thus
we do not speak ofthepossibilityofasystemthatcanaffectanotherautonomoussystem,butfor
a new treaty that is determined by the therapeutic relationship and defined by the context in
whichsocialeventsevolve(inourcasethenursingfacility).
In this sense, therapy is a metacondition (a higher level condition) coconstruction of
meaning (Bruner,1990),withtheuseoflanguageasabasictaxonomyandmediationofcomplex
communicationalprocesses(Watzlawicket.al,2011).
Based on the above sayings the therapist is not perceived only as a guide, but also as a
companion that when conditions require guides or treads along or follows the teenager in the
recovery path.Thepurposeoftreatmentisnotsomuchaguideastoinventtogetherhowtobuild
roads.
Nursesaccompanyteenageidentificationssometimesasalternativeparentingmodels,or
asauthenticsubstitutesforphysicalabsencesorevenastransitionalobjectsofteenage
compulsions.Thetherapistandthepatientworktogethertobuildatherapeuticviaspeech

reality.Thistranslatesasadisputetowardspower,whichwastheresultofthedifferent
knowledgepossession(Foucault,1980),aswellasashiftingofthetherapistfromaknowledge
2

positiontoacuriositypositionandultimatelyairreverence positionagainstthepredetermined
shapesofknowledgeandpractice(Cecchin,1992)
Theold,embeddedandinavastdegreefunctionalshapes(ofdirectionandcontrol)are
3

naturallydominant. However,itisnowmoreopentopostreviewandrevisionmomentum.The
changeofposition(andviewing)allowsevaluationofattitudesnotexclusiveasalinearresultof
basicandunvaryingpersonalityattributes,butmainlyasaresultofcyclicalrelationsof
interactionbetweenindividuals(Selviniet.al,1980).
Althoughthisperspectiveis"narcissisticblow"inthecomplacenttherapeutic
omnipotence,itcanaffectthemercifuldynamicbalancesystem,tothedegreethatallowsaself
reflexiveconsiderationifpossiblefreefrommythsofcausalexplanations.Self(Tsekeris,2010),
isratherreflectivelyrecreated,necessarilyintertwinedwiththe'realworld'anddialectic
reassembledthroughcontinuous,reciprocalandsynergetic(chaotic)selforganizedinteractionof
theegowith:
1.Theemergingofthesocialstructures.
2.Withthesignificantothers(real,imaginary,orimplied).
Withtheabove,itisunderstoodthatthesystemicthinkingandpracticedoesnotreplace
otheropposites,itexpandspreviousmodels,suggestingnewwaysofflexibleconsiderationof

Ofcourse,asCecchinwarnsusinorderforustobedisrespectfultowardsatheoryweshould
firstknowitverywell.
2

Wemustnotforgetthatfromaninstitutionalstandpoint,thenursingteamdoesn'tworkbased
onthepoliticalandinstitutionalgapbutwithinthelargerphysiciancentredhealthmodel
specifiedbythepoliticalrequirementsofthestatutoryorgansoftheState(Government,
DepartmentofHealth,HospitalAdministration,etc).
3

therapeuticreality,inwhichthebehaviorisnotaresultofstaticcharacteristicsofpersonality,but
thecomplexandinteractiverelationshipwiththePersonandthecontext.
Thetheoryofcomplexityreferstosystemsthatexhibitcomplex,universalbehaviorsas
aresultoflocalinteractionofcomponents,orfactorsthatconstituteandwhosebehavioris
determinedwithrelativelysimplerules(Cohen&Stewart,1994).
Inastatic,homeostatic"world,therapistscanagreetoobserve,tointerpret,toclassify
onthebasisofprefabricatedshapesdescribinghowmustthe"normal"teenbe.Whilepossessing
theabilitytodeterminethedegreeofdivergenceofspecificadolescentthanthenorm,the
therapistscaneasilysuggestwaysforrestoringbalance.
Contraryinthefluidityofcomplexity,thereisnowaytoknowhowthenormal
teenagermustbe.Whatwedoknowisthatwemustremainavailableandcurioustounderstand
thedistinctrealityofeachteenager.We(nurses),withourknowledgeandourvalues,operateas
prototypesofpossibleoptionsandnotasknowledgeableofthesoleroadforeach"truth."With
theuseofcollaborativedialoguesasaninvitationforaneventualpathtowardschangewhile
maintainingtherapeuticresponsibilityasaguidetoprotectfromarbitraryinterpretationsand
abusivepractices.Thisconditionprotectsthetherapeuticrelationshipfromtheriskofextreme
4

arbitrariness whereallversionsarejustasgoodastheothers,withoutatthesametimeallowing
theeffortlessreturntothepastsimplified"knowledge".
AccordingtoAnderson(2013),acooperativedialogueisacommunicativeprocessthat
hasthefollowingcharacteristics:
Itisanatural,spontaneousactivitythattakesplaceeachtime.

AsstatedbySchweitzer&Schlippe(2008),inthetreatmentreductionthereistheriskof

arbitrarinessandthe(subsequent)deficiencyindiscussion(p.99).

Itincludesthecollaborativedesign,whichrequiresaninvitation,thelearningandthe
respectoftheotherperson'sexperience.
Eachdialogueisonlyforattendees,situations,circumstancesandthedailylayout.
Differences,suchastheintensity,clarity,uncertaintyetcarenecessaryforaproductive
dialogue.

Thedialogueismultidimensional.

Eachmeetingdiscussionandrelationshipispartofthepast,present,andfutureofthe
participants.

Thedialogueimpliesofamultiplicityofvoices,presentandabsent.

Thecontextisthebackdropforthedebate:Thehistorical,cultural,organizationaland
relationalcontext.

Thecooperativedialoguepremises:

Totalk,tolistenandtorespond.

Thefullconfidenceandabilitytobeopentotheopinionsanddiversityofothers.

Nottoassumethatyouknowwhattheotherpersonmeans,nottofillinthegapsor
theelementsofthestoryofanotherpersonthatyouthinkisbehindthestory.

Checktomakesurethatyouunderstandtheotherpersonsperspectiveasbestyou
can.Understandingdoesnotmeanagreement.

Timeforinternalandexternaldebate.

Timeforinteriorandexteriorreflections.

Theuseofpausesandsilencesprovideopportunitiesforreflection,internaldebate
andpreparationforspeech.

Thuswesuggestthatwithintheframeworkofthecooperativedialogue,theuseof
alternativeexplanativeshapesandtolookfordifferences,exclusions,andtwiststhat
couldcauseafirstandminimalyetcrackintheconcretewallofthenarrativesofthe
disorder.

Applicationofsystemicideasintoeverydaypractice
Ineveryorganizationtherearetwochannelsofcommunicationflows.Theformaland
theinformal.Theformalisexpressedbytheofficialorganizationalchartanditsinstitutional
rolesofpeople(Patient,Physician,Psychologist,Nurse,Head,Subordinate)andunofficialthat
specifyingtheinformalcommunicationsamongmembers.Accordingtotheet.alAllen,(2007),
theinformalnetworkofcommunicationismostimportantfortheformulationofthedynamics
withintheorganization.
Takingtheaboveintoconsideration,webelievethatthetransformationofinformalinto
formalcommunicationhelpstomanageemotionalreactionsandimpulsiveoperations,itgives
voicetonegativefeelings,itsatisfiesthesenseoflaw,itdemystifies,anddedramatizesreactions,

itclarifiesmisunderstandingsandaboveallitrecognizestheteenagerpatientasperson,in
accordancewithRogers(2012)philosophy.
FromtheverybeginningoftheoperationofAICUworkinginsmallgroupsisused
widelyinthetherapeuticprocess.Teengroupmeetingsarecreatedforcrisisresponse
procedures,forexpressingemotionsandforconflictresolutions.
5

Thereisnoclearstructureinthesegroupmeetings .Inadditiontothebasicrulesof
decentsocialinteraction,therearenospecificprocedures,stricttargeting,typicaloressential
programming,norofcoursechallengingandexclusionprocedures.Everyoneisfreetojoinorto
withdrawfromthesegroupmeetingsatanytimetheywishinacompletelyvoluntarybasis,even
duringthesession.Evenso,thebasicelementinthestandardtreatmentgroupcontext,changes
whenandifcircumstancessorequire.Groupmeetingshavetakenplaceinthe
Multipurpose(recreational)room,inthenursesoffice,inHeadNursesoffice,inthediningarea,
inthechildren'srooms,inthecourtyard,dayornight,with2or10kidswhereandwhenthe
needsrequire.
Webelieveinthedirectuseofthesmalladhocgroupasaneffectiveconflictresolution
andregulatingemotionsmechanism.Initscoreitisasifthereisapotentialgroupmeetingthat
runssowithoutschedulefromtheverybeginningoftheunitoperation.Theonlythingthat
changes(orIswhatremainspermanent?)istheconstantrotationofmembers,inaneverending
appositionofnarrativesandpersonswhoconcoctthethreadofAriadneinthespacetime
continuum,creatingasenseofintimacyandsafetyevenforthemostisolatedsocialgroup
members.
6

Theadolescentnarratives arefollowedbysilences.Thesupportglancesarealternated
withinterjections,theemotionsareshifted,andthelongpastsilencedvoicesemergein
Theadolescentgroupmeetingsarenottherapeuticteamswiththestandardmeaningofthe
term.Theyareconsidermoreopportunitiesforconciliationandinteractionbasedonthehereand
now,inotherwordsintheeverydayrealitythatthebordersets.Ofcourseinthedailyoperation
ofAICUthereareformalgroupse.g.focusgroups.
5

Bulimiainanyinstancecanbealifelineinthedeepseaofemotionalemptiness

consciousness.Inthiswaythesilenceofthementaldiseaseisabolished,itl iquidatestheultimate
dysfunctionalrealityandultimatelyitbecomesamoremanageableweightofpsychicpain.This
7

reframing processallows"safe"approacheventothedeepestwound asitclotheswithreason

eventhemostintimateandrepressedexperience,thatofnakednessandsexualabuse.Allthisin
anenvironmentofsafetyandempatheticunderstandingwhichispromotedthroughthefollowing
mechanisms:
Theacceptanceoftheteenageraswhohe/sheis(Rogers,1995).
Absolutefreedomtoexpressthoughtsandemotions,eventhemostjudgmentalfor
thetreatmentgroup.
Thenonjudgementalattitude.
Oftheselfdisclosure.
Ontheotherhandthereflectivespeechofthetherapeuticgroup.Theexplanation,the
experience,theexample,theapologyforanywrongpracticesandthehealingpowerof
forgiveness.Yalom(1983),believesthatthegroups,withinthehospital,haveatimedurationas
asession.Forusthereseemstobeacontinuousgroupsincethebeginningofoperationofthe
AICU.
Theconceptofcircularcausation,amomentousmeaningofthesystemicthinking
allowsustomoveawayfromtheunproductivegameofrecriminationsandconflict.The

Duringanadolescentteammeeting,oneofthegirlsreportedobviousfeelingsofshameand
guiltforherarrestforprostitutionoutsideoftheOmonoiaPoliceDepartment.TheCoordinator
reframedtheincidentsayingthat"Onlyadeeplymoralpersonlikeyouwouldchoosetohustle
thecorneroutsideapolicestation".
7

Althoughcoordinatorstryofcoursetofocusdiscussionsonthehereandnowandthe

relationshipsamongstadolescents

relationshipisnotlinear,itgetscoconstructedin(concentrated) thehospitalizationperiodand
unreelspirallyinspace/time.Thefundamentalskillofempathybecomesanobjectivefor
process,likethedisclosureofindividualresponsibilityfortherelationalgapsinthehereand
nowofeveryteenagerslife.
Thecoordinatorofgroupmeetingswilllookatthedifferencesthatmakeadifference
(Bateson,1972).He/Shewilltrytoharvestinformationfromadataset,he/shewillfindthe
differentperspectivesofteenagers,he/shewilltrytosynthesizethedifferentvoicesofthegroup,
he/shewilllookforexceptions,thecracksintherobusttellingofthedisease.Thepurposehereis
tohighlightareasonforyesterday,therecastingofhistoryofpain,thestapleofmnemonicgaps,
providinghopeandofcoursetheconsolidationofasenseofcontinuityforadolescentssuffering
10

fromunbearablelackofmeaning .
Theconceptofscapegoathelpsusobservewithcriticallooktowardsourpreferencesin
11

taxonomies,classifications,ontheaxisofDSM2 .Whatarethereasonsthatsomechildrenare
moreengagingthanothers?Howcome,tosometeenagers,weareavailableformore
concessionsandgreatertolerance?ArebeautyandintelligenceasaHalophenomenon(Nisbett
&Wilson,1977),abletoblurourjudgment?Arethetragicstoriesofsomechildrenthereason?
Isitthattheylooklikeus?Isthatwesharewiththemcommonfate?
Whatisthenursesroleinallthis?Thesystemicwisdomtellsusthatwhenweseea
child,deepdowninside,ourstoriesmeet.Voicesofoursignificantothersinsideourheads.Our

Denseinsenseofdisproportionateburdenedcommunicationalmessagesandemotions,in
respecttoanormalteenager'slife.
9

AparticularlyusefulexerciseforgroupsofteenagersistheTreeofLife,whichcomesfromthe
NarrativeSchool.TheTreeofLifehasbeenusedsuccessfullyinthetreatmentofchildhood
traumainparticularlyhardandviolentenvironments(e.g.wars,pandemicsandAIDS)...more
abouttheTreeoflifecanbefoundonthefollowinghyperlink
http://dulwichcentre.com.au/thetreeoflife/
10

11

Axis2ofDSMincludespersonalitydisorders.

ownwoundsandourowngaps.Thedeadendsthatwehaveexperienced,thesolutionswegave,
choicesanderrorsinwhichwemighthavefalleninto.
Ouractionshave,ofcourse,amultitudeofeffects.Wedevelopspecialrelationshipswith
somechildren,webecometheirpersonofreference,butwedonotceasetobemembersofthe
treatmentteam.Ourpresenceiscompletedattheendofoureighthourshift,butthechildwill
12

naturallycontinuetostay,evenafterourdeparture.
NaturallyAICU,likeanysimilarorganization,isbasedonthebasicdictatesof
Behaviorism(reward,punishment,operationallearningetc.)inanefforttoputundercontrolthe
deviantbehaviors.Behaviorismhassomeadvantages,whichareimportantinclinicaltreatment
ofacuteincidents.Themainadvantageisthatitactseffectivelyinashortperiod.Ontheother
13

hand,moderndevelopmentsofpsychoneurology disputesmuchofwhatwetakeforgranted.
The"difficult"childrenaren'tnecessarily"difficult"becausetheywanttobe,butbecausethey
cannotactotherwise.Thebrainisnotabletocorrectlyperformthecomplextaskofemotional
regulation,resultinginareducedabilityofsocialinteraction.Thecomfortinghereisthatthe
14

brainhastheabilitytolearnanewwaysofinteraction,usingthemechanismofneuroplasticity
(Rakic,2002).
Whatisneededistogivevoicetotheteenagersactionsofimulsivityandaftertohelp
themgainproblemsolvingskills(Green,2008).

BasedontheperspectiveofthePersonofReference,Ihadoncedevelopedaspecial
relationshipwitha"difficult"childwhofeltsosafewithmypresencealone,thatheslept
peacefullywhenIworkedthenightshift.Iconsideredmypresencetherapeuticforthechildand
highlyproductivefortheplacement.Notmuchtimewentbyforthelivinghellthatthechildwas
goingthrough(aswellasmycolleagues),whenIwasnotworking,tobediscover.Allnurses
havesimilarstoriestotellbasedontheirexperiences.
12

Forexamplewefinallyknowthathumanbehaviorisformedintheprefrontalcortexandthat
manyofouradolescentsbelonginClinicalclassifications(ADHD,ODD,PTSD)showing
deficitsinnormaldevelopmentandfunctionalityintheaccordingbrainarea.
13

Theneuroplasticityreferstotheabilityofthebraintorecreatenervesynapsesandtorestore
functionality.
14

Thephenomenonofrevolvingdoor(Haywoodet.al,1995),frequentreadmittedincidents
15

andthefrequentadjustmentdifficultiesoftheadolescentsinotherenvironments brings
skepticismtowardshowrewardsandpunishmentsarelikelytocausesubstantialandlongterm
sustainablechangeinthelivesofteenagers.MostchildrenwhoarehospitalizedinAICUhave
sufferedinthepastanumberofreprimandsandpunishmentsfromdifferentcontexts(home,
school,legalsystem)withratherpoorresultsinchangingthebehavior.Thespecificteenagers
seemtohaveacquiredimmunitytopunishments(Lewis,2015).

Constructionofmeaning
Lifeofcoursecouldcontainitsmeaning.Faithhelpsinthatsense.Thebeliefinthe
indestructibilityofsoul,thebeliefintheafterlifeandtheirheavenlyvindication.Christians
believethatalltheseexist.Butnothereandnotnow.Incontrasttheexistentialistphilosophers
suchasNietzsche,andKierkegaard,(McDonald,2005),donotbelievethatlifehasany
substantivemeaning(May,1961).Themeaning,isinaccordancewiththeirownwritings,isa
personalresponsibilityandaduty.Themeaningiswhateveryoneofusattachestohislife.
Theimportantthings,themeaningfulrelationships,values,ideals,dreamsandhopes.The
signspointingstraightaheadandbackintime.Comingfromthepastasinvisiblethreadsthat
bindustoourancestors.Mythsandnarrativesoffamilyhistory,ghostsandshadows,happyand
sadmomentsofdistantandremote,throughnarratives,names,nameoflocalityandmaps,
formedintoshapesandattitudesthatgivethepersonasenseofcontinuityandcompetence.

15

Forexamplethereturnhomeorschoolafterbeingdischarged.

Sometimes,however,issometraumaticeventsinchildhood,thatcauseruptureand
discontinuity,whichspreadtothefourpointsofthesoul,towardsanynotionoftrustand
security.
"Nothingisasitwasbefore.Whatwouldfilltheexistencewithloveandcertaintyisnowan
intolerablesourceofpain,anxietyandabandonment
Insequencethedesperateattempttosurvivefollowsthechild.Thatnecessarilywilllimit
thecomplexityofemotionstothebasicsthatreachtheprimordialemotionsofthebody.An
attemptofintegrationonwhatisremainedafterthefragmentationanddisintegration.Thechild
clamsupsoitwillnotstrewinpsychosis.Freezesinternallytokeepincheckableedingwound.
Andthevoid,theabsenceofinternalobjects(Matsa,2008),hoveringinside.Thechasmwhich
swallowsinsatiablethemeanings,theimportantandinfluentialoflife,donotfindsomewhereto
clickandcrumbleendlessly.Thisisthecostforthisunbelievablepainofmemorynottobelived
again(Miller,2003).
Soslowlybutsurelythechildstopsfeelingsohe/orshedoesnotremember,causespain
soastofeel,itseeksupondestructiontopretendthatthatshe/heexists,she/heusesconsolations
towarmup,he/shetriestokillhimselforherselftoremember(andtoremind!)thatonlythe
livinghavesuchanoption.
Thevastmajorityofchildrenhospitalizedinhaveatraumaticchildhoodandteenaged
years.Sexualabuseinparticular,iscausinganumberofAICUnegativeimpactsonchildren.
Permanentlyitinjuresthebodyandsoulandleavespersistentscarsintimeandtreatment.
Particularlythesexualabusethatisperformedwithinthefamilybringsthemaximumnegative
impact,totheextentthatunderminesthedestructioninsenseofsecurityandconfidence,basic
characteristicsforhealthyrelationships.Thechildtocopewiththepainandconfusionbuilds
cognitiveschemesthatdescribeitselfwiththedarkestcolorsofobsolescence,ofselfblame,of
shameandanger:

Dadisgood,forhimtodowhathedidtome,itismyfault.
I'mnotworthytobeloved
Relationshipshurt
IfItrust,Iwouldgetexploited
Theseshapesare,descendantsofthebipolarchildhoodthinkingbutalsooftheneedfor
survivalinaharshenvironment,getconditionedastheyfollowthepathtoadulthood.Allsortsof
relationships(friendly,erotic,professional)getcrowdedwithinthisnarrowemotionlessmold.
Pervasiveeroticism,seduction,manipulativemaneuvers,dramatization,obsolescenceand
idealization,allinserviceofasingleemergency,toconfirmthebasicshapesofthe
selfworthlessness.
Thei nteractionsisnotamatterofchoiceinthiscase.Thechildwillconnectintheonly
wayhe/shelearnedintheabusiveenvironmentthathe/shegrewin.Thisconvinceshimorher
thathe/sheisunworthy,diabolical,thathasadarkandcunningpiecethatlivestopunish.He/she
isnowcertainthatcametolifetodestroyandbedestroyed.Withtheabovebehaviorhe/shewill
beproperlyadjustedsothat,asaselffulfillingprophecy,soonerorlaterwillcausethemaximum
fear.Lonelinessandabandonment.
Inthisway,theotherpersonisnotinvitedinthechild'slifeasacompanion,friendor
classmate,butasaspectatortothetragedyoffragmentedexistence.He/shedoesnotbecomea
helperandacompanion,butaseawallofemotions,grief,envy,objectoflust,ofworship,of
hatred,ofidealizationandofdevaluation.Everysooftenthenursinggroupbecomestheobject
ofthesearchaicassociations.Sometimesasanidealizedmother,andsometimesasadeadly
Medusa,aspartialsymbolandasaChimerianfigureofaninternalworldseparatedintotwo.Just
thewaytheprimaryobjectwassplit.
Relationsaretreated,oftenintermsofenduranceanddistance.Howmuchwillyoulast
nexttome?Ifyou'renearmeI'minpainandifgoawayI'mafraid!Asaresultthedeep

existentialpainofrejectioncontinuouslygetsignitedbytheweaknessforrelationshipswith
emotionalattachmentandsubstance.Inthedeeppainofabuseisaddedandthedailypainofthe
lackofmeaning.Andadrop,alargeorsmallfromthedailyroutineisneededfortheglassto
overflow.Thenthepainbecomesunbearableashe/sheexplodeswithviolenceagainstthe
unworthyself(Gustafson,1986).Selfinjuries,riskybehaviors,suicideattempts.Anddeathstill
seemsnotsoobnoxious,atleastnotmorethananabioticlife(Linehan,1999).Treatmentatthis
stage,isnotgivenverbally.It'smoretreatedby:
I'mhereforyouandIamabletobearyourownpainandmyfearofliability.
Idonotjudge,behindwhatyouaredoing(whichisunderstandableunderthecircumstances)
thereisawoundedsoulwhoneedscare.Thewordsandthetechnicalitiescanwait.
Inthiscriticalphasethecareofthenursingteamispriceless.Thewarmthofahug,care
andgrooming,themirroringofemotions,thecontainment.Thecontainmentisdefinedas
placingalimitaroundanexperienceorfeeling.Theexperienceorfeelingissubjectto
managementorrefusal,itcouldbemaintainedorpassedon,anditcouldbeexperiencedor
avoided,sothattheirresultscouldbealleviatedorstrengthened.Bion(1970),describesthe
relationshipbetweenthecontentandthecontainer,indicatingthatthecontainercouldactas
eitherafilterorasponge,tomanagedifficultfeelings,oritcouldbecomearigidframethat
preventsorlimitsthusmakingthecontentwhichmaybeexperiencedasathreatoras
salvation.
TheNursingteamhastheheavyloadofbecomingtheobjectofteenageimpulsions,often
actingasalightningrodfortheoverwhelmingnegativefeelings.Thegoodenoughmother,
accordingtoWinnicott(1960),isableandwillingtoendureinher"hug"(holding)thewhole
destructivenessandhatredtowardsthechild'sprimaryobject(symbolicallythefemalebreast).In
thiswaythenursingteamisthemetaboliteofpainfulfeelingsbypreventingtheonsetofthe
actingout.

Withtheaboveprocesseshospitalizationbecomesfortheteenagers,asignificant
restorativeexperience,meetingwiththeotherpersonandidentifyingwithbetterstandards.The
ultimategoalofnursinginterventionistohelpadolescentstobecomecompetentforreal
meaningfulrelationships,throughthepracticalassurancethattheydeserveloveandacceptance.
AsaptlyphrasedbyParis(2008),Peoplecan'tfindalovethatlasts,oragoodpersonuntilthey
feelthattheydeservetobeloved".

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