Playing Hard at Life brings contemporary relational thinking to
bear on the psychodynamic treatment of a notably difficult group of
young patients. 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 committment (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 assures 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.
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. Her relational approaches to these treatments, teamed
with her realization that work with multiply traumatized
adolescents cannot be structured in the manner of conventioanl
therapy, makes this book an invaluable, timely, and deeply sobering
contribution to the literature.
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