Time to talk
"Right," says Julia Boutall, her gestures birdlike, her accent thick Hungarian. "Does anyone have anything they would like to talk about today?"
There is a moment's pause around the table. But this is not a problem: here, silence is part of the job description. Sarah Fielding raises her hand. "I've got something I'd like to talk about," she says. And then she tells Natalie's story.
When Natalie was 16, she was accosted by a flasher at the school gate. The incident traumatised her and she responded by dropping out of school. At her worst, she would not leave home without her mother, would not answer the telephone by herself.
One year on, however, she was gradually rebuilding her life: she had enrolled in school again and begun work towards three A-levels. Then, a month ago, her elder brother was the victim of a gang-related attack and the police moved the entire family into a safe home, with only one bedroom between the family's three teenage children. Natalie is therefore sleeping in her mother's bed, regressing to a state of childlike neediness.
"When I saw her yesterday, she was very, very tearful," Miss Fielding says. "She was scrunched up in her chair, very foetal. She says she feels it's all her fault: she is the bad penny. She said she has had visions in her head of committing suicide, throwing herself under a train. Oh, God."
"Hmm," the woman opposite, frizzy hair pulled back into a ponytail, says. "Hmm," the man next to her avers.
There are 12 people gathered around the table in the upstairs meeting room at the Brent Adolescent Centre. The room is cheerily functional; tables form an open square in the centre. DIY shelves are stacked with textbooks: one is labelled "families", another is marked "depression", yet another "suicideself-harm".
"A lot of young people come in with suicidal thoughts or suicidal tendencies," Miss Fielding, the centre's mental-health worker, said before the meeting began. "The risk of suicide is so much greater in adolescence: some teenagers have a fantasy that it isn't death at all, that they are going to float off to a better life. It becomes a fantasy, where the hated parts of their lives are removed."
The aim of the centre is to create a second chance for these adolescents, to compensate for an inadequate or incomplete childhood, by intervening before personalities - along with fears and neuroses - become set in adulthood. If they are treated in time, a depressed or suicidal teenager can become a fully functional adult.
"There is a process most of us need to go through in the adolescent years," said psychotherapist Danny Goldberger, as staff members trooped in and gathered around the table. "It is ultimately very difficult to get away from that process. That is the role of this service - to recognise that there is something very particular about adolescence, but also that it is a phase, and we all come through it."
Pupils are referred to the centre by schools, social services, local- authority mental-health services or themselves. The cases that the in- house therapists take on range from victims of gang violence and sexual crime through to asylum-seeker teenagers wracked by survivors' guilt. But pupils also come to discuss the everyday unhappinesses of teenage life: depression, family trouble, and eating disorders.
Hearing such stories on a regular basis can take its toll. The centre's staff gather once a week to discuss particularly troubling or problematic cases. As the meeting progresses, each case is discussed and analysed in turn. Around the table, Mitteleuropean inflection competes with New York analyst-speak. At one side, Egle Laufer, the centre's octogenarian founder, drops casual interpretations into conversation. References to parents are not uncommon; the vocabulary of Freud and Klein peppers the conversation.
Early on in the meeting, assistant psychologist Korina Soldatic brings up the case of Rosaline. Rosaline was 11 years old when her mother died. She had been living with her father in Sierra Leone for years; she and her mother had only recently resumed contact. She does not know what it was that killed her mother.
Again, there is silence.
Finally: "Was the mother a prostitute?" the frizzy-haired woman asks.
Last year, staff from the centre worked with 87 pupils from Brent local authority. Group sessions are conducted at two of the borough's schools, Kingsbury and Preston Manor, with participating teenagers selected by pastoral staff. Groups are conducted in different formats: boys-only, girls-only, and mixed gender and age.
"Brent is a big borough," Miss Fielding says. "And Asian girls in particular aren't given much independence to travel around. If we come to their school, they can see us without too much intervention from their parents. There is a fine line between battling for independence for teenagers and knowing that they need their parents' help to get here."
Danny Goldberger is responsible for running several of these groups. He leans forward in his chair. "Can I talk about one of my cases?" he asks. "Can I talk about Kamna?"
Kamna is a 13-year-old high achiever. Active in the school's maths Olympiad, as well as several after-school clubs, she was volunteered for one of the centre's girls-only groups by her head of year. True to form, she was initially punctual and diligent in her attendance, while shying away from any genuine revelation.
Then, one session, she suddenly revealed that her father was a chronic alcoholic. Her mother works long hours and she is regularly left alone to clear up after her father and her baby brother. She has mopped up both vomit and faeces. On more than one occasion she has had to rush her father to Aamp;E.
"She kept it away from school, because school was her haven," Mr Goldberger says. "Now, she doesn't feel like that any more. She doesn't take part in activities any more. She feels that she is not good enough."
The role of the school is vital in such cases: without perceptive teachers on-hand, stories such as Kamna's might not come to light. "You are very reliant on the relationship with the school," Mr Goldberger says. "This case is testament to a very thoughtful head of year, who could see that some pupils were excelling, but that there might be some vulnerability that is worth attending to. Schools are full of people who are emotionally in touch with the pupils they are working with."
Often, detecting potentially troubled teens can merely be a question of knowing what to look for. If pupils are consistently getting into trouble at the end of each half-term, for example, they may be struggling with the emotions that the forthcoming holiday stirs up. "But it can be quite difficult to see what is in front of you," Mr Goldberger says.
In recent group sessions, Kamna revealed that her father has been in hospital again, receiving in-patient treatment for several weeks. "She is furious with him," Mr Goldberger says. "She quite wanted him to stay there or die. It has been just the three of them at home and the idea of him coming back is just awful.
"She is very angry, and despairing of all adults. Then there was half- term: school closed, me not being there, her mother working. She just feels . left."
"Does it feel like she has contaminated school now?" asks Sebastian Kohon, looking up from his notes at the table.
Mr Goldberger nods. "She was holding a lot in, having to be falsely strong," he says.
"Hmm," Mr Kohon says. "Could she be worked up to coming here?"
"Coming here" is the next step up in the centre's work. Teenagers are seen for regular "interviews", a form of therapy-lite that allows for greater flexibility than formal psychoanalysis. Each appointment is confirmed at the end of the one that precedes it, enabling teenagers to take responsibility for their own treatment. This is particularly vital among secondary-aged pupils, often struggling to separate from their parents and find their own identity.
Not all pupils progress from group work to individual interviews. And, equally, not all interviewees will come to the centre: where possible, interviews are offered on school premises.
Occasionally, when centre staff deem it appropriate, pupils are also offered formal psychotherapy. These sessions take place in airy rooms off the centre's narrow corridors, often two or three times a week. Light streams in through large windows, pot-plants lean against pastel-coloured walls. Each room also contains a therapist's couch, spread with a white throw. ("Some kids do say, `What's that bed for?'" Miss Fielding says. "For some, there are obvious sexual overtones, but that is not uncommon in adolescence.") Every room also comes with a set of chairs: it is up to the individual teenager whether to sit or lie down during sessions.
"Sometimes we just need to provide a holding space for young people," Miss Fielding says. "We get some who say they want to move in. One person laid down and said he wasn't leaving one day. They just want to curl up and go to sleep here."
Back in the meeting, Sebastian Kohon shrugs off his suit jacket and begins to talk about one of the pupils he sees for regular psychotherapy sessions. Kadim is 15 years old and has been seeing Mr Kohon for almost a year. He was referred to the centre after a series of incidents at his school: he was involved in a number of fights and was accused of sexually harassing classmates. Last term, he was repeatedly excluded.
Kadim's father is an alcoholic; his relationship with his mother is strained. He regularly vanishes for entire weekends. Now, he has announced that he wants to see Mr Kohon during school hours. The school has agreed, provided that Kadim goes straight on to school afterwards. But Mr Kohon doubts the wisdom of this plan.
"I'm a bit worried about Kadim waking up, thinking, `I don't want to see Sebastian today' - and then not going to school, either," he says. "He spends a lot of time not in school, out and about. If he doesn't come here, he could just be out and about. But it would be stepping out of role for me to tell the school he didn't come and see me."
Again, there is silence for a moment.
Finally, Mrs Laufer speaks. "I think you are right to be worried about it," she says. "This boy is on the verge of being excluded. He is borderline and quite anxious, and his way of dealing with it is to exclude himself.
"His father is an alcoholic. Now he is becoming a man, with the potential of becoming a father. What is it in his father that he is afraid of in himself?"
To leaven the mood, Dr Boutall intervenes with a story of a happy ending. Jasmine had been sexually abused for years, before her family found out what had happened. At the age of 16, she was referred by her school for interviews at the centre.
When she first started seeing Dr Boutall, she talked a lot about her boyfriend. During the course of her sessions, he began to be physically abusive. Jasmine ended the relationship, but the boy apologised and begged to be taken back. Jasmine refused.
There is an audible sigh of relief around the table. "Oh, well done!" someone breathes.
Her relationship with her mother has also improved. "Her mother cooked," Dr Boutall says. "There was always a meal there for Jasmine. She was nourishing her, in a way. Even when they couldn't talk, she cooked. Now they talk."
Since beginning to see Dr Boutall, Jasmine has developed a clear career plan: she is taking five AS-levels and plans to study law at university. "She felt she had achieved," Dr Boutall says. "So. Happy ending."
As the meeting draws to a close, talk turns once again to Natalie, Miss Fielding's disconsolate 17-year-old. "Obviously, I was left with a worry," she says. "Should I have done more yesterday? I don't know whether - if - she is really suicidal."
"Has she ever made an attempt?" Dr Boutall asks.
"No," Miss Fielding says. "But this is the first time that she really feels she has done everything wrong. It used to be: everything's so unfair, everyone did everything to her. Now she is taking on some responsibility. In a way, it is a good thing, but I was a bit worried."
"And you have been worried before," Dr Boutall adds. "Didn't you get the Samaritans to ring her over Easter? And she survived then."
"Yes, she did," Miss Fielding says. "And I did tell her she could ring in over half-term and I would get back to her." She sighs, and shuffles her papers. There is no more to say, the meeting is over.
As staff members file out of the room, they all feed their agenda sheets into a shredder in the corner. In their business, client privacy is paramount. This, however, creates problems of its own: there can be no end-of-the-day offloading sessions with friends in the pub.
Inevitably, this can take its toll. Asked to take on the case of a teenager who has been trafficked to Britain and abused by her uncle, the frizzy-haired woman opposite Miss Fielding refuses point-blank. "I'm quite burnt out with these sorts of cases," she says, matter-of-factly.
But these are therapists: handling pain is what they do. And this is why the weekly meeting is vital. "We are human," Miss Fielding says. "So, obviously, some cases move you. But you get a chance to talk to each other. That is what helps. You have space to think things through and understand them. If you have got thinking space, you have the chance to work out what a young person needs."
"Yes," Dr Boutall says. "Many of us wouldn't take such cases in a private practice. But here, we have the facility to talk about it. We have the luxury."
The late-afternoon sunlight filters through the room's net curtains and a shaft of sunlight catches the "families" shelf. "I used to work in the outpatient ward of a hospital," Miss Fielding says. "You would have a few incidents on the ward and staff would just go on a crazy party binge, because there was no other way of dealing with it.
"Here, there is much more thinking about things. Sometimes you have to bear the pain of that, live with it. It is much harder. But it is a much more satisfying way of dealing with it."
*Names and some details have been changed, to protect teenagers' identities.
Photographs by Julian Anderson