The dual process of adolescent immigration and relocation: from country to country and from childhood to adolescence--its reflection in psychodynamic psychotherapy.

This chapter presents psychological issues and processes in adolescent patients who have also migrated or relocated from one country to another. Theoretical perspectives related to attachment processes illumine both migration and adolescence as changes for which secure bases are most needed, lost, and sometimes rediscovered. The psychodynamic processes underlying the difficulties encountered by such adolescents, and their meaning, are presented. Relationships with parents, which normally go through separation-individuation and renegotiation of the oedipal crisis, both of which are central to adolescence, are disrupted by migration. Migration poses new challenges and choices while identity formation is evolving during adolescence. These include adopting a new identity, embracing and letting go of the old, and accepting and integrating the new. The dual relationship with identity finds expression, for example, in language. Fluctuations in understanding and not understanding the new and the old language represent the ambivalence toward the new and the old. The developmental roller-coaster of adolescence, which involves more intense use of defense mechanisms, is heightened during immigration. Processes of idealization (of parents, therapist, old country, new culture) rapidly fade with the devaluation of the same targets. Mechanisms of splitting between good and bad, as well as massive repression of issues that are too hard to deal with at this crossroad, are profuse. Hopeful fantasies of rebirth are concurrent with despair, depression, and, in some cases, suicidal thoughts and attempts. Excerpts from a case in psychodynamic psychotherapy are presented, focusing on the evolving new balances: integrating the old and the new by maintaining attachments to the one while forming attachments to the other; relinquishing and mourning the lost paradise of childhood, as well as the old country, friends, culture, smells, and tastes; accepting disappointments when the shining new terrain of the new country is not the fantasized promised land; negotiating processes of splitting that have been employed in the false hope of quieting the internal turmoil of the transitions (the good vs. the bad country, parents, therapist, and developmental tasks); finding new ways of coping with the deep despair of losing all the above, and the urge to give it all up; and, finally, forming an integrated identity, built on both the old and the new. The processes are elucidated by examples from the psychotherapy of an adolescent Ethiopian-born immigrant to Israel.