So we're going to get started. I'm Karen Gilmore. This is Pamela Mearsand. We co-wrote this book, Emerging Adulthood, a Psychodynamic Approach to the New Developmental Phase of the 21st Century. OK, can you hear me better? Oh dear, OK, got it. OK. So this is our book, which I assume you can find somewhere on one of the tables out there. I have to say I'm a little puzzled by the subtitle of our, or the over title of our talk, which is Characters Remaining. Anybody know what that means? I have no idea. But it's not my, I didn't put that insert in. Anyway, I'm going to present a brief synopsis of the concept and of the controversy surrounding it. And then Dr. Mearsand will explore the key concept of identity and identity formation and maybe mention a case. OK, what's a collision? What's a collision? OK, so, better this way? OK. So throughout its history, the field of psychiatry has stretched to accommodate expansions and new directions, especially in its understanding of the boundaries of human development and the evolution of ego capacities and conflict. Adolescence in 1904 and infant psychiatry in 1945 and 1965 opened up our domain to in-depth examination of the complexities of these phases, informing our sensitivities to the origins of psychopathology, diagnosis, and techniques to promote change. Our relative openness to incorporating new findings and new theories arising in these arenas, like attachment theory, mother-infant relationships, mentalization, and the early origins of character disturbance has enriched the entire field. Our book explores the most recent addition to this series of new arenas, emerging adulthood, which encompasses the age range that has been traditionally viewed as late adolescence and young adulthood, namely 18 to 24, and then ultimately was extended to be 18 to 29. But now it's been reconceptualized as its own developmental phase with its own tasks and challenges. This new entity appears regularly in resident curricula and in child and adolescent journals. The new phase of emerging adulthood is not just a question of nomenclature. It is consequential to our understanding of the origin and the course of many illnesses. This will be my focus shortly. But simply considering the question of proprietary rights, many child clinicians view this age group as best approached from the point of view of child and adolescent development, providing context for it as a continuation of the developmental arc. But emerging adulthood with its own challenges, biology, and phase-specific conflicts is also firmly within adult psychiatry, given the age range, and represents a cultural phenomenon arising from the techno-sociocultural world of the 21st century. As we discuss in our book, emerging adulthood was originally introduced by Geoffrey Ornette in 2000, the year 2000, as a theory of development of 18 to 24-year-olds and has been widely adopted by developmental researchers and child and adolescent clinicians. Its evolution is elaborated in our book. Here is a brief synopsis. Introduced by Geoffrey Ornette, the theory asserts that in today's world, there is a prolongation of the period between the end of mandatory education, namely 18, and the assumption of adult roles. By the end of this extended interval, eventually encompassing 18 to 29, the tasks of identity formation through role experimentation and the gradual stabilization of affect, values, circumstances, and life choices are achieved. This period is characterized by identity explorations, instability, self-focus, feeling in between adolescence and adulthood, and optimism about the future. Ornette's theory and these descriptors are the basis for a wave of research that followed and continues to this day, amounting to almost 300,000 research papers in the ensuing 20 years at my last admittedly casual library search. Ornette was eager to analogize his discovery to the discovery of adolescence at the turn of the 20th century where changes in child labor laws and the establishment of mandatory education led Stanley Hall to the recognition and elucidation of an adolescent phase distinguished by mood disruptions, risk behaviors, and familial conflicts. Following this revelation, a century of research, controversy, and clinical observations and theorizing refined and deepened our understanding of adolescence, establishing it as a crucial period of physical, sexual, and emotional growth that culminates in the mental organization of the adult. Similarly, Ornette contends that the sociocultural conditions at the turn of the 21st century ushered in the rapid transformation of our society into a techno-digital informational economy, the advent of global communication, the demand for innovative thinking, and the erosion of traditional pathways to adulthood. According to Ornette, these changes paved the way for an extended period he calls emerging adulthood, a new developmental interval extending from 18 to 30, where ongoing brain plasticity, the process of identity formation, the acquisition of required technological skills, maturation of cognitive capacities, stabilization of the superego, and development of the capacity for mature relationships gradually evolved to create a new contemporary adulthood. Ornette's idea is that emerging adulthood is not a transient phenomenon characterizing a specific generation, like baby boomers, millennials, or Gen X. Rather, it is an addition to the accepted developmental series, like adolescence. Dr. Mearshen will talk in greater detail about the core challenge of identity exploration after my remarks and its role in the development of certain types of psychopathology. Here, I will focus on the controversies that persist about emerging adulthood. Similar to the history of adolescence, there are disagreements about many features of the emerging adult concept and the theory behind it. Here are some that we discuss in our book. Many of these remain up for debate. First, there is debate about its universality. Does this same phenomenon exist in different social, racial, socioeconomic strata within our culture and in other Western post-industrial countries or in Eastern societies? Does it exist in developing nations? While Arnett has been clear that emerging adulthood is the outcome of cultural transformation, originally studied among college students, where most of the research still focuses, theorizing has been extended to include all strata of society where other Western post-industrial countries, Eastern countries, and non-industrialized nations. In my opinion, some of this literature airs in the assumption that anyone between the age of 18 to 24 or 18 to 29 grapples with the specific developmental phenomenon that Arnett has described. Subject selection is often based on age only. Nevertheless, there has been an accumulation of observations in diverse developed countries in different strata of our society and in developing nations to support the idea that this is not confined to privileged white college students. Many of the same epidemiological trends that alerted Arnett to this phenomenon have emerged across the globe in the last 30 years. Later marriages, later childbearing, later assumption of adult roles and financial autonomy and a consequent de-standardization of pathways to adulthood. It is reasonable to suppose that the cultural differences shape these de-standardized pathways but that they all represent a form of emerging adulthood. Another debate concerns a value of proposing a 12-year continuous developmental experience. Our book has made the case for the importance of maintaining late adolescence as a concept or at the very least recognizing that emerging adulthood must be seen as comprising distinct early and late parts. After all, it has been widely accepted that adolescence has early, middle and late parts, albeit with some disagreement about how these should be delineated. The lay public and emerging adults themselves readily recognize that the vast differences in maturation in regard to one's status in the world, stability, individuation from family of origin, established identity, interpersonal maturity and subjective experience between the beginning of this period at 18 to its completion at age 30. Moreover, this new developmental extension is closely observed by younger people and inevitably alters the experience of every part of the developmental arc, especially adolescence, where anticipation of a lengthened time frame reduces the urgency of so-called adult commitments, enlarges possibilities and reinforces the idea of taking your time. Today, it's not until the second half of emerging adulthood when future directions get set, where young people get much more serious about life choices and demonstrate a more settled identity and value system. Unfortunately, Arnett's original designation of 18 to 24 and his original research cohort set the pattern of using college students as their prime subject. When the age range was extended to 29, the college student cohort continued to dominate the literature, no doubt due to the challenge of studying an older age group not collected into a community. It's very difficult to find research that focuses on this older half and elucidates its vicissitudes. There are other points of controversy with Arnett's theory. The ones I would like to emphasize today relate to the fundamental question of whether the phenomena that Arnett has called emerging adulthood is better understood as psychopathology, be it generational or individual, rather than a new developmental phase. Gene Twenge, a psychologist and social commentator who is widely read in the popular press has quarreled with Arnett, insisting that this is a generational phenomenon and reflects a narcissistic turn due to the special circumstances of millennials, also known as the me generation. In her new book, Generations, she describes the millennial generation, which encompasses the first wave of emerging adults born between 1980 and 94, as raised on indiscriminate praise and self-love from infancy compounded by the self-focus perpetuated by social media. According to Twenge's research, millennials are the most wanted children of any generation given the advances in birth control technology. Not only are they the most wanted, but from birth they are encoddled and encouraged to self-realize and be self-focused. In a culture at peak posterity and optimism, they are raised to feel good about themselves and to expect a lot of success. While they were not born into the established digital society, they witnessed and indeed participated in the transformation of our culture into a fully mediated world. Since the commercial internet was really available in 1995 and the arrival of the smartphone in 2007. They are the generation that saw the birth and blossoming of social media. They grew up in a culture of deliberate parental enrichment and low-pressure adolescence and the young adulthood. For them, becoming an adult or adulting is a process and needs time. In summary, millennials are the culmination of the general trends of technology, individualism, and the slow life strategy, according to Twenge. They have learned to put the individual self first. In contrast, she describes the features of the following generation, Gen Z, born between 1995 or 1997, born in 1995 or 1997 as more concerned with authenticity, diversity, gender equality, and free speech. Arnat challenges Twenge's allegations of narcissism, indifference to the state of the world, and rampant individualism by questioning her data, primarily based on college samples, faulty survey instruments, and self-reports. In their published debates, there was little discussion about the fundamental difference in their conceptualizations, namely that Twenge's career and current argument concerned with describing generational differences. She is characterizing millennials and their deficiencies. And while Arnat argues with her about the features that she decries, there is a more significant divergence between them. He is describing a new developmental phase, one that presumably will see the coming and going of millennials, Gen Zs, and future generations. Twenge does not seem to engage with Arnat's insistence that his observations reflect a change in developmental progression. The question then is not whether Gen Z differs in regard to greater social consciousness, but rather are core emerging adult features present, confirming the idea of a developmental phase. Gen Zers are still following the epidemiological trends of delayed assumption of adult roles and extended role experimentation. They still demonstrate many forms of instability and risk behaviors. If other emerging adult features are in decline in Gen Z, this allows us to parse Arnat's descriptors into generalized traits and those that are fundamental to this new developmental extension. Some qualities Arnat applies to emerging adults may pass within a given generation. Another debate centering around the question of psychopathology versus a new developmental process is about whether emerging adulthood should be seen as a pathological extension of the adolescent process, an updated version of Blos's prolonged adolescence with an expanded application. One could make the case that the failures to resolve the identity crisis, to abandon risky behaviors, to mature out of youth culture, to settle values and ideals, and to commit to an autonomous life direction reflects a pathological extension of the tasks of the late adolescent phase. This applies as well to failure to complete the intrapsychic process of maturation of the superego, establishment of self-determined identity, evolution of theory of mind, ongoing growth, and reliability of executive capacity, the deepening of relationships, and the requisite flexibility and complexity, both intellectually and interpersonally, that you see in older emerging adults. The concept of prolonged adolescence was first identified by Bernfield in 1923, and later developed by Peter Blos in 1954, and revised in 1979. The cultural circumstances at the time of these publications were very different, the first in post-World War I Europe, and then post-World War II America. But both clinicians are commenting on certain syndromes that seem related to the socio-emotional impact of societies under transformation, not so different from the social challenges of today, where educational access to advanced technological skills and the demand for higher levels of proficiency have led to longer and more specialized education. Blos elaborated the intrapsychic elements. The prolonged adolescent was determined to keep the identity crisis open, to resist commitments to the external world, and to avoid the fixed... Oops. Sorry. Structuralization of mental organization and finalizing of sexual identity, superego, and ego interests into the form that was viewed as the achievement of adulthood. Of notice that some of Blos's descriptors may apply specifically to millennials who are critiqued for their expectations of greatness and recognition based on parental promises and coddling. As Blos famously states, their great future is behind them. But these descriptors can also be interpreted as just another way of naming features that are net claims in general for the emerging adult experience. A related and more ominous version of this debate is the question of how readily the diagnosis of personality disorder is applied to adolescents and emerging adults. As you may be aware, this is by no means a new question. From the 1904 publication of Stanley Hall's two-volume work on adolescents, where he coined the expression Sturm und Drang to describe normative adolescent instability, there have been debates and disagreements about the inevitability of overt and covert conflict, instability, and chaos in adolescence. Do these symptoms reflect normal adolescence or disturbance? Certainly the proponents of his ideas were not directly diagnosing severe psychopathology, nor were they excluding it, recognizing that in the midst of the upheaval of puberty, reactivation of oedipal conflict, and proneness to action, adolescents can fall prey to mental illness. In regard to whether these represent the nascent form of Axis II diagnoses, our DSMs up to DSM-5 bar the diagnosis of personality disorders, except the antisocial in anyone under 18. It was only in the 21st century that the specific pathology of personalities disorders was recognized to begin in adolescence. In the 1990s, there was a small but growing literature about personality disorders appearing in early adolescence or younger, and about the stability of impairment traits and emotional regulation strategies over the course of adolescence into adulthood. By formally including the alternative model of personality disorders, the DSM-5 provided at least one vehicle... ..for assessing personality on a dimensional scale. Of course, Kernberg's group bases the diagnosis on their in-depth interviewing and assessment of personality organization, so focuses on a deeper level of analysis. But the situation is complicated by the insertion of emerging adulthood into developmental progression. Given that the idea of emerging adulthood, by definition, extends a time frame for a range of instabilities, including the superego and relational capacities, and it's all about identity experimentation, the implication is that the normative development... Normative development involves a level of chaos that extends into the 20s. For some clinicians, they may... This may tilt the diagnostic impression towards psychopathological entities consistent with a borderline diagnosis. The question then becomes, is it developmental or is it psychopathological? Is it a part of the tempestuous age stage that young people grow out of, or is it a deformation of personality that persists? Adding to this dilemma is the fact that personality disorders do have a natural course and quite consistently improve over time. Know that we should differentiate symptoms from underlying personality structure, but if the incidence of borderline symptoms declines in a relatively consistent time frame, could that not be a manifestation of developmental issues, albeit perhaps extreme ones that people grow out of? Or is it character pathology? This is a quandary familiar to child clinicians since Abrams and Neubauer's classical series of papers attempting to distinguish the developmental from the psychoanalytic, by which they mean conflict-based. The struggle to differentiate developmental from etched-in personality pathology brings me to the final question that many of you have been anticipating. What is the role of social media and the internet in creating such an atmosphere of pervasive narcissism that it leaves a stamp on the majority of young people in this era? Indeed, the central role of the digital revolution is the background music to some of these controversies. The transformation of our society, the advent of the internet, smartphones, and social media have led to dire warnings about their impact on human development, headed by concerns about the narcissism of social media with its focus on accumulating likes, the pressure to craft an ideal self on one platform or another, and the opportunities to conduct relationships without real contact or intimacy. This is a widely discussed topic within psychiatry, psychoanalysis, and by social commentators like Turkle and Twenge. There is no question that social media sites, the current-day version of the playground mall and town hall of adolescence and emerging adulthood, promote a preoccupation with admiration, self-creation, and self-promotion. There is little disagreement about the culture of child-rearing that these commentators invoke, since millennials' parents and millennials themselves are widely characterized as providing an indiscriminate parental approval and reassurance, much like the parenting that Blost observed in mid-20th century in creating the prolonged adolescent. These are contemporary phenomena that shape the forms and experience of emerging adulthood, but they are not one and the same. Indeed, I would suggest, based on clinical experience alone, that the Gen Z approach to child-rearing is quite different in ways obvious, such as the willingness to leave their infants in the first six months of life for weeks at a time, and in more subtle ways as well. However, the assertion that overweening narcissism colors the emerging adult experience is, in my opinion, contradicted by a neglected aspect of their sensibility. That is the widespread and vibrant youth cultures with devoted adherence, where real people gather in real time and really connect and engage around real political issues and environmental issues. We devote a chapter to youth culture and discuss its role in scaffolding identity development as young people move from school into society. Dr. Mearsheim will now speak to the questions of identity development and psychopathology in this period. Okay, I'll just speak briefly about identity and then we'll open up for comments and questions. I emphasize identity because in many ways it is the centerpiece of this developmental period and of the five pillars that Karen mentioned as being pillars of the concept of emerging adulthood. Exploration and identity self-definition, that process has the greatest overlap with our work, both in terms of how we assess people in this age group, how we think about their overall functioning, and also in terms of how we position ourselves within an ongoing treatment, the role we serve, the functions we serve vis-a-vis people in this age group. A couple of things to keep in mind before talking about the conceptual aspects of identity, just some contextual factors. A number of writers noting the elevated rates of anxiety and depression and substance use in this age group have speculated that part of the reason that there has been a rise in those, and they're largely talking about the self-reports of college populations, which is where one can actually do the greatest amount of research. A number of people have speculated that there is something about this prolonged post-adolescent phase, pre-adulthood proper, that has opened up a greater vulnerability for young people because of the prolonged period of instability and experimentation, which for some young people marks a sort of difficult process. And if you think about what's required for the kind of identity experimentation that Karen was referring to, it very much requires lived experience. And in some way, it's the first time in the developmental cycle when it is no longer sufficient to fantasize about who you wanna be and who you wanna be with and what kind of person you wanna be. You actually need to get out there and do things with your real body in real time and have experiences. So if you imagine the plight of a very anxious, inhibited kid, a depressed kid, a kid who's high all the time, that very much impedes one's ability to engage with life. It's also sort of interesting to think about the impact of the COVID shutdowns on this age group where you had a lot of young people who were maybe sent home from college where they were exploring and experimenting for the first time. Or if they were out working, all of a sudden those jobs either went away or became far more solitary and easy socialization certainly was eliminated for a period of time. So there's been some interesting research on what the immediate impact of that was like on this age group. Another factor to keep in mind is that these emerging adults are functioning often with the parents having taken a step back, whether they're in college or they're on their first job. Some of them have moved away from home so that in terms of the recognition of the need for mental health services, it's no longer a situation where, as in pediatric health where your parents note that you're having some difficulty and they bring you to the right person. These young people are very much on their own to recognize when they need some help and to seek help. And there is therefore a huge gap between the actual need of the population and the rate at which they do tend to come to mental health professionals. So in terms of the theory of identity, the person whose name is most closely associated with that is Eric Erickson. And I think interestingly in the psychoanalytic community to which Karen and I belong, he was largely ignored for many years but has enjoyed a little bit of revised interest but he was thought to be too sociological in his thinking. However, he remained very popular within academic psychology sort of parallel to what happened with attachment theory. And I think one of the motivations that we had in starting to think about and write about these topics had to do with trying to sort of reintegrate some of this research that had been done outside of the psychodynamic community. It was being very actively done within developmental psychology, academic psychology and sort of bring it a little bit closer to some psychodynamic concepts. But Erickson's idea was basically that identity is the part of the personality that functions at the interface of the individual and society. And it is the part of personality by which we recognize ourselves and others recognize us. So it lends a feeling of solidity, of cohesiveness, of constancy. You recognize yourself and in interaction with someone else, they recognize you and there's a feeling of consistency there. And part of what is interesting and complex about his conceptualization of identity is that he saw it as bringing both stability and flexibility to the personalities. So stability in the sense that you feel like a recognizable person, you have a sense of who you are. And he thought of identity as encompassing not just conscious constructs like, these are my opinions and I tend to be shy when I'm in a crowd, but also is encompassing unconscious forces such as defense mechanisms. But along with the sense of solidness and cohesiveness that goes along with identity consolidation, he also saw it as a source of flexibility in the personality. So in other words, you feel solid enough that you can entertain a new idea. You can meet a new person who's different than people you've been with before. And there's a sense that you can adjust to that, you can accommodate the novelty of that experience without losing your sense of yourself. And that becomes very important when you apply it to intimate relationships and to what we expect to be the sort of growing ability of this age group as they traverse late adolescence through emerging adulthood to engage in intimate and more prolonged relationships that you don't fear that you will lose your individuality if you accommodate the needs of another person. You can put somebody else's needs and preferences even before your own, and that is not a threat to your sense of self. So these are some of the basic ideas that Erickson had. And although he saw identity as a lifelong process, he did believe that there was a high season for this kind of development during late adolescence and early adulthood. One concept that I think is particularly interesting is his notion of what he called a psychosocial moratorium, which was the idea that young people in the midst of this identity exploration require a bit of time and a setting which allows them to playfully explore without having to make final commitments. So he was writing in the 50s and 60s, I think had college in mind as a sort of ideal moratorium, which makes sense if you think about college with its numerous offerings. You can study these different things, get exposure to new ideas. You don't really have to commit yourself to future roles quite yet, but a moratorium can be offered in a number of different settings. It really just requires that the young person has a certain amount of time and leeway to experiment, to try out a certain job, to meet new people, to have different kinds of relationships, and to engage in some manner of exploration. What is very central to his concept of the moratorium and what I think maybe sheds some light on this controversy about whether or not these young people are just sort of self-indulgent and narcissistic, his notion is that the social milieu is crucial and a formative part of the identity process so that part of what happens is that the young person will, in effect, audition a part of the self. They'll try something out, whether it's a novel gender identification or it's being with a new person or it's joining a new political group with a particular purpose in mind, and they will then immediately seek response, recognition, and validation from the surrounding group. So that makes the peer responsiveness a key part of the process. So there's trying out or auditioning an aspect of self, experimenting with that, seeing how you feel about it, seeing how the people around you respond to it, and then engaging in some reflection and reconsideration. And that's basically the process. So I think the notion of there being a display aspect to this, or there being a requirement for an audience, in this theory that is really a part of the normative process. And certainly if you imagine the impact of social media, this kind of exploration that maybe used to take place within a very small surround is now on view. I'm reminded of this young woman who I've treated for a number of years, who was in her 20s, her early 20s, going to college at a time when Facebook was what everybody was using humorously. I'm still treating her. She's now in her 30s. And she was reflecting on this on Thursday, because she now uses TikTok. And she was explaining to me that she made a TikTok about, at the age of 30-something, about her college-age self. And she was recalling for me this event where she'd gotten off to college. She's a girl who came from a very tight-run home ship, where the parents exerted a fair amount of control. And she did not feel that she could really experiment, particularly in regards to gender, because it was a pretty strong religious background that she felt prohibited that. But she got onto a college campus where there was a lot of such experimentation going on. This was very exciting for her, and really opened up new ways to experience herself. And at one point, she made a Facebook posting about coming out as bisexual. And what she was recalling was the intense preoccupation following the posting with how many likes she would get, who would respond, who wouldn't respond. And this went on for some days. And she was recalling the intensity of that, and joking about how she still really likes to get a lot of views on her TikToks, but it doesn't have a devastating effect if she didn't. But again, I just point out that what she was describing from her younger self, within the theory of identity development and exploration, is sort of normative, and in Erickson's view, was necessary. I think the other comment I would make about the accusation of narcissism is that if you think about what it takes to traverse this period of time, and to engage in this manner of exploration without always exactly knowing what the response of your peers is going to be, it reminds me of this very nice paper by Eichler, who was the head of student health at Columbia University, which is probably a very complicated job right now. But he wrote this lovely paper in which he describes that you really need some grandiosity to get through emerging adulthood. You have to have some belief in yourself. You have to think you can do it, particularly because it is a little bit of a way station, where you don't have the family support that you once did. You're a little bit more on your own, and the future isn't completely scripted. So it requires normative narcissism and a little bit of grandeur to sort of get through. And then just getting back to the concept of identity exploration, I think a lot of Erickson's original theory has been borne out by research, because what often gets written about is this process, very much as he described, that there is a little bit of experimentation across a variety of domains, not necessarily in sync. You may experiment with sexuality before you experiment with your political beliefs. But then in all these domains, there seems to be a similar process of trying something out, seeing how it fits, reflecting on it a little bit, and then sort of maybe holding on to it, maybe moving on to something else. And then that process seems to continue over the course of many years. I think as we've both alluded to, there's a lot more known about the active phase of this process, because most of the research is on college students who are a captive audience. It's a lot harder to get hold of 28- and 29-year-olds, you don't tend to find them all in one setting. But that seems to be the description of the process. And just to briefly segue into working with this age group, I'm interested to hear about what all of you think and what your experiences are working with emerging adults. But I think often the therapy itself becomes a form of moratorium where the young person uses the treatment as a safe setting to try out some of these identity explorations. And the response of the therapist then becomes also quite important. And I think that can lead to a certain amount of difficulty. It can be a challenge in treating this age group, because on the one hand, we don't want to put our finger on the scale. We want to encourage the process and not be overly invested in a particular outcome. I think that can be a difficult balance to achieve. We are naturally, I think, more active with this age group. I think we need to be. Again, there is this gap where the parents or parenting figures have often stepped back, sometimes stepped back too much. So we are in the position of filling in the void. But often, this is a large part of the work that we're doing with this age group. So maybe we'll open up for some comments. Any of you working with emerging adults? If so, you probably have a lot of thoughts. For me, sure. I'm a private practitioner in a college town, and a large portion of my practice is what you describe as emerging adults. And yeah, I have so much questions, and we could just talk on this for so long and ask so many different questions about it. But the first one that came to mind is when you're talking about trying on identity things. What about the issue of maybe identifying with a psychiatric diagnosis, and trying on DID or autism spectrum? So I'm kind of interested in that, in addition to beyond gender roles or stuff. And then another sort of idea that came to mind, I'd wonder if you'd comment on it, is if this period is prolonged, and if maybe it's a vulnerable phase, and that maybe there might be a lot of injuries happening, and then development of mental illnesses, do that prolong? Like, being a large target now, because it's prolonged, and maybe that has a role in the sort of mental health crisis that we're seeing, or seem to be seeing. Well, I mean, I'll respond first to the comment about trying on, sorry? I think the question had to do with, you know, our having identified this prolonged period of development in which there is a kind of normative degree of flux and change, and whether that in and of itself contributes to current mental health crisis among young people. And I mean, I think there is speculation that it does, in fact, that there's a correlation between the rising levels of distress that young people are reporting, but also the, you know, not just self-reports, but also, you know, the data that reflects an increase in suicidality. I think there is some speculation that there is a correlation, and that a lot of young people are struggling with this period because of the nature of the ambiguity and the uncertainty that it brings to us. I think in terms of the specific point you made about, you know, identity exploration with psychiatric illness, I think we all see that if we work with this age group, that there's a lot of sort of, you know, like taking on different symptoms and, you know, sort of playing into those almost, and, you know, wondering about what that means. I mean, I assume that part of that is, you know, a very positive decrease in the stigmatization of mental illness and, you know, the reduced level of shame that is associated with carrying a diagnosis and seeking help. I think what's interesting and concerning is that despite that, there remains a huge gap between the level of need for mental health treatment in this age group and the rate at which they are actually seeking it. I also find that people, I completely agree that there is this kind of tendency to name oneself. I'm ADHD, or I'm OCD, and it sort of stops the whole process from deepening and trying to understand where their symptoms are coming from, where their difficulties are coming from. So I think it is a kind of, maybe part of the whole wellness, maybe it doesn't seem like it, but maybe part of the whole wellness trend, but it is problematic and it sort of curtails depth in treatment too. I have a slightly different read on it. I take care of a lot of the parents of these people. So, you know, if the kids are in an exploratory, they're exploring, it's very helpful to reassure the parents that adulthood, it takes much longer for this generation than for their generation. So that's fine, and that's really helpful for parents. Where I'm really having difficulty is there are kids who don't even get into the exploratory phase. They're up in their bedrooms, they're smoking pot, they're not working. Do you have any suggestions for how to help their parents deal with these kids who aren't moving into this phase? Well, I mean, I think these are the failure to launch but more seriously ill kids, I think. And some of them are, I mean, in terms of parental response to that, I think parents eventually have to either get the kid help of whatever kind is necessary, like substance use help or depression, but also have to set limits at a certain point, which I think is very difficult for parents to do. It seems to be very difficult for some of the parents of these kids. For example, I mean, I think some parents decide to make the kid contribute to the household because if they're living in their bedroom and not doing anything and the house is continuing to run, they have to contribute in some way or other. So that pressures them to earn money or to do some major work in the household, which usually is bringing in money to the parents. So, I mean, I think that is a very reasonable demand on a 24-year-old who's living at home. This is also this problem of kids returning home from college and staying there, and that's what leads to the kind of problem that you're talking about. And it makes parents very, I mean, some of the literature suggests that parents get quite depressed from this. They feel burdened by it. They feel like they're failures because they haven't gotten their kids out the door. So it is a big problem for those. Okay, well, thank you. I don't think I'm missing anything. Having parents set limits with these kids is a trick. It's not the reason. Yes, it is a trick. Okay, thank you. Yeah, and I think you're also, you know, raising the issue, which is, you know, pervasive throughout child and adolescent treatment, is like, you know, if we are treating the young adults, you know, do we have contact with the parents? You know, I think that question about parent work and what its role is with this age group, which I think can be quite complicated because it's often very helpful to have some contact with the parent. They're certainly, you know, the best source of early developmental information. And if they're still quite involved with their kid, it can be very useful for the treatment. But then it also, you know, often threatens to override the young person's sense of autonomy. Good morning. I find those on the spectrum would have a particularly difficult time in navigating the emerging adulthood. Could you advise us how to help those who have so much difficulty in forming their own identity since they don't really care to be like the others, but they get so depressed because they know they're not like the others? Thank you so much. Can you say a little bit more about what, how you approach such people? Any? Yeah, I just try to screen for any depression or internet use, which we see so common now. So I just want to ask your take on how do I approach them psychodynamically, since I have no idea how. Thank you. Just, you know, and the question is just, you know, any general thoughts? I'd be happy to hear from any of you in the audience as well about how best to address young adulthood in patients who are on the autism spectrum. Are there any, you know, particular approaches that might be helpful? I think you were asking specifically from a psychodynamic perspective. Well, I mean, I think that this, I don't know that you're really thinking about support groups, but I think that there are a lot of very useful spectrum, kind of organized spectrum support groups that I think have been very helpful. But you know, I think it depends on your overall orientation. I think that it's very helpful to talk to these kids about what their experience is and their limitations or the areas of difficulty for them so that they, you know, can identify what's going wrong in certain situations. But it's often very difficult and it's often helpful to engage other, the peers and to help them help each other. Because I think that that's been found in some of the studies of treatment facilities that are specifically for emerging adults that using a peer to facilitate some of the tasks that they have facing is much more beneficial than using a parent for sure. So but you know, it's a complicated issue for sure. I think it's true that individual treatment alone is often not sufficient, and I think this particular population really suffers from the lack of structure that is often part of this developmental phase, the ambiguity, the uncertainty, and also often the slight loss of parental support, although I think often these kids are, you know, are able to continue living with their parents and need to, but I'm just thinking about one young woman I'm treating who's in her mid-twenties, you know, who would, you know, would meet criteria for mild autism, probably as somebody we would have called Asperger's a number of years ago, so, you know, she has a lot of language but a great deal of difficulty interacting with others, has a very hard time handling unstructured time, managing her, you know, regulating emotions, et cetera, and so, you know, I meet with her twice a week for what I think is a psychodynamic individual psychotherapy where, you know, we do talk about how she's feeling and her reactions and, you know, sort of go over the events of the week with an eye toward, you know, a little bit of an analysis, but she's also in a social group with other young people who are having difficulty and she also works with somebody who is like kind of an organizational person and she finds that very helpful. It's like a psychologically minded tutor and, you know, just like this wonderful individual who talks with her about pragmatic things, you know, like, you know, what to put on a job application and, you know, what planning the weekend, you know, where is she going to go? Is she going to do that sort of thing? And that, you know, that seems to be containing her pretty well and I think she has made, you know, made some progress over the last year, year or two. Parents are very frightened, of course. Considering what you've been saying, I would imagine you have feelings about the use of telepsychiatry with this group of people. Talk a little bit about that telepsychiatry. Yes. You must have feelings about that and where it's placed, whether it has a place or whether it really should be avoided. Well, I mean, it certainly has a place in terms of addressing this gap between, you know, the high rates of mental health needs and the, you know, the lack of services. So I think that to the extent that it allows us to reach young people that we would not otherwise be able to treat and that it maybe offers them, you know, at least an initially, you know, a form of treatment that feels more comfortable and more familiar. I think it's a real asset. I mean, in terms of the quality of the treatments, you know, I think if you're treating somebody who's nearby who can come to your office, I think having that real experience in real time with a young person where you get to see, you know, how they use their body and what they're like when they come in the door, I think that's absolutely crucial. But I, you know, I think telepsychiatry and also, you know, these apps that have become mental health apps that have become very popular, I think to the extent that, you know, the quality is adequate and those methods reach more young people, I think they're highly desirable. Yeah. I mean, a lot of this population... I would think that collecting good data on something like this might be really very important for the future. And you realize that many kids in this group started with someone in high school and then they go off to college and there's that question of continuity. And I think that often continuing with the same person is of value and, you know, then they... Or they go to college and they start with someone and then they leave college to go to some place. And so I think the continuity that's provided is very helpful. But I think it should be studied. I agree. It's an interesting question of that particular population that we're talking about. Hi. Thank you for this talk. I wanted to ask a question about you reframing the idea of this prolonged period of time in terms of emerging adulthood more recently because of increased opportunities to explore identities, I think, in this era. And I'm wondering if you feel that this maybe prolonged period of time of consolidation of identity makes for a longer period of treatment that is necessary to help with that. Or I guess another way to frame it would be whether there is any role for us as psychotherapists in the sense of any particular emphasis that we need to put on in that period. Because I know you mentioned, Dr. Merson, about the moratorium to explore the identities and sort of putting a stress on what we are... Sort of how we respond and how that would affect the patient. But even in the sort of like how the patient kind of comes up with their own final more consolidated sort of sense of self? You know, I find that sometimes it is longer, but sometimes they come and go. You know, they get to a certain place and then they do what they're doing and then they come back when they are finding that they are shifting their values, their beliefs, or their ambitions to something else. And also problems in relationships come up. So I think it is, I think it's a great thing to offer an open door to these kids and let them come and go. The longer treatments, yeah, I mean, I think there are long treatments. But I think it's always individual, determined individually. Yeah, you know, I think it's a really interesting question about the length of treatment. I mean, I do think just in terms of like general principle of working with children and young people, you know, you kind of want to see development on track, I guess is the phrase. And as long as your sense of the track is not like a narrow linear track, I think that's a perfectly fine like guiding principle. So I don't think it's that you need to treat until there's, as you were saying, a consolidation. Because I think that consolidation may not quite be what happens with identity, right? This is really a lifelong process. But I do think that there's a role for treatment if the identity process feels stalled, foreclosed on, you know, I mean, the example I, you know, I think of as, you know, a young person who's like, you know, too depressed to engage in lived experience or too anxious, too inhibited, too, you know, high all the time, whatever that is, then I think there is an important role for the treating clinician to try to, you know, soften some of those problems, free up the capacity to explore identity, you know, as much as would be appropriate for that person. And whether, you know, what's, you know, getting in the way is conflict-based or whether it's a substance abuse problem or mood disorder, I think there's, you know, there's certainly a role for us there for as long as that takes. So, yeah. Going back to the situation where you're treating the young adult and you have a sense that the parents are overly coddling or that there's some issue that needs to be addressed there, but your young adult does not really want you to have the contact, how do you manage that situation? You hope that you can get the patient to the point where they can refuse the coddling, you know? I mean, I think it really is a question of facilitating their individuation and growing maturation. You give up on the idea of ever dealing with the parents. Well, I would only have the parents in with the patient and obviously only if they agree. I think that's often useful. And parents' involvement in treatment with this population is very valuable according to some of the centers that have grown up around the idea of having a very wide-ranging treatment approach, patient, parents, friends, you know, the whole. So I think it's important to maybe, if it really seems as if it's essential that you deal with the parents to convince your patient that it's important. And you would have them there with your patient and still be able to do the individual therapy? How do you manage that? You mean to see the parents with the patient? Yes. You know, I guess us child people tend to do that all the time, you know? So I think it's not that uncommon. I think you can't be the person who tells the parents what to do, particularly when it's not what the patient really wants to do. So that's difficult. But I think you can kind of nudge them into seeing where certain things may benefit from being handled differently. Yeah. It's difficult, though. I think that particularly with very, very affluent kids, for example, whose parents are providing them an apartment and, you know, allowance and so on into their mid-20s, it becomes really an impediment to their move forward, to having any real pressure on them to move forward. Thank you. I think that is the description of some of the more difficult cases in this age group, these kids who feel very stuck and who seem to lack the motivation to move forward and, you know, where they don't want the parents in, they really don't want any changes to the status quo. I think inherent in Erickson's theory about identity development, there's an assumption of an engine there that is the young person's own drive toward autonomy, you know? So there's the assumption that there's some internal process, set of pressures that kind of, you know, pushes their development forward. I think when that is lacking, it is extremely difficult. You know, in Ornette's first, earliest research, he questioned his—these were college students that questioned them about their—what they subjectively saw as adulthood because, you know, adulthood had been defined for decades as marriage, childbearing, independent domicile, financial independence, and these things really were not cited by his research subjects. They said being able to make your own decisions and taking responsibility for your decisions are the two features that they continually spoke of. So I think that is a—recognized as a part of their movement forward that they need to take ownership of themselves, but obviously this is a problem where there is interference in that development, either internally or in the environment. Do you recognize a difference in sex, male versus female, in terms of their stage of development and how they progress? Do you have an idea about that? I would think. I hear a lot about men living in their parents' basements and women are taking this opportunity to move forward, and men are more delayed, and I'm wondering if you've seen that yourself. You know, it's interesting. I have seen—I mean, just based on clinical—my limited clinical contact with this population, I think it's much more common for the men to be the ones who are languishing in the basement and not the women. I mean, I think women can—despite all the advances, I think women feel to some extent a pressure to move forward, biologically speaking, if they want to have children. So certainly in the latter part of emerging adulthood, they are looking to get settled in that regard because they want to have—you know, average age of marriage now is 27, and that's pretty close to the average age of the first child. So I think that that is a pressure on women. I don't have any other—do you have another theory about it? I was wondering if the elimination of the draft have a role to play. That's interesting. I don't know about that. It was, you know, it was an identity-creating experience for a lot of people, sometimes identity-destroying in some of the traumatized people, but it did create a kind of way to consolidate identity, or at least temporarily consolidate identity, and also required them to be autonomous, from their parents anyway, to move away from their family. And, you know, a lot of the identity that emerging adults need to shed to some extent is what's been assigned to them by their family and their hometown or whatever other community thing is seeing them a certain way, you know. They have to, like, readjust their whole self-image based on what they discover as their own talents and their own interests. So the Army—well, I don't know that it—I guess it does provide a lot of people career options and training, which is wonderful. It's not necessarily an identity that most people who go into the Armies embrace. I mean, they don't all stay in the Army, right? So I think it is, but it does give an example of how to, you know, sort of consolidate your identity and your interests. And I've met a bunch of young men who have gone into the Army because they wanted the training that they were going to get from it, you know, in flight, like learning how to fly, learning how to do certain kinds of skills, and then move on after that. And that has been retained as an important part of their sense of who they are. I don't think I have much to add to that. I mean, I think there probably are fuller answers to these questions in the sociology literature where they, you know, they tend to look at the impact on different groups of people of the loss of traditional pathways to adulthood. But I think it's a very interesting question. Yeah, it reminded me of a young man that I treated, actually, I treated him from childhood through his mid to late 20s, actually, intermittently. But he was looking to, he was really eager to enlist because he felt that that would make him into a coherent person with an identity of his own. He happened to be the child of very, very high-profile parents who would, he was sort of part of the entourage of this family, and the youngest child, and really felt he couldn't find himself in it. Of course, his parents were very much against this, because they were, you know, progressive parents and so on. But I think it did appear to him as a solution, and I think he was always seeking his band of brothers that would be a peer group that would be supportive. He did end up becoming a firefighter, though, which is another way to solve the problem. Thank you for this. This is starting to turn so many wheels in my mind that I have many questions, but I'm very interested in the failure to launch population. I'm in an outpatient substance use clinic in Queens, and I'm relatively new to New York, and I'm kind of noticing this unique failure to launch population here, maybe because partly it's so expensive to live in Queens in New York City in general, and I'm just curious if you've had any kind of impressions or noticed anything specific about cost of living here, substance use, and if it's really adding to this failure to launch. We've actually, we're trying to figure out a name for a group that would get young people to actually join. Failure to launch is not a very attractive name for a group, but we have this young adult group, and it was supposed to be 18 to 24, but we have all of these patients who are kind of 24 to 32 who are very much getting stuck in living in mom's basement, a lot of substance use, which is really kind of stopping them from even entering into this exploration phase. They feel kind of hopeless and helpless because it's so expensive to move into maybe a more independent living situation, and I guess I don't really have a specific question, but as all of these questions are coming through, maybe if there's anything you've noticed in any specific ideas you have to address or support this population. Yeah, I would just say that living at home is problematic for so many reasons. Absolutely. Like having a sexual relationship, or having a bunch of people over who have beliefs different than your parents, like some kids who become much more politically active one way or the other than their parents. Those are two very minor examples, but they're significant because it just kind of puts a damper on all movement forward, and I think the economy of it is definitely true. A lot of young people move a little further out, you know, in the city anyway. Barora, are you in? I'm at Zucker Hillside Hospital, the Long Island Jewish General Campus in New Hyde Park, Queens, and it's expensive there, not as expensive here. So we've certainly been trying to form communities and make it a little bit more, even acceptable to have roommates. I think a lot of these young kids also have in their mind they need to stay home until they can afford a house, and we have to shift that thinking to go, affording a house is really a massive, massive goal. What if we could enter into the steps along the way? What if we could open up some space for that struggle? Even though there's a lot of fear of living with roommates and living in maybe not the nicest apartments or having to worry about bills, this is a very important part of moving forward, and I think there's so much fear, not only from the young people, but from their parents. It's such a difficult experience to watch their children struggle, and so I think they are trying to protect them from a struggle that's really actually very normative and helpful and productive in them moving forward. You know, I think this is also where you see the role of youth culture, maybe not in providing them a living space, but also in engaging them in a very vibrant, active culture that they can begin to, you know, obviously develop a peer group, see their future. Sometimes, like, even, you know, people who are, like, Taylor Swift fanatics, and there are mostly in this age group, which astonished me to know, but, you know, some of these people who follow music groups or musicians, they eventually go into the field, not as the talent, but as the producers and the organizers and so on. So these youth cultures provide things like that that can help them to, you know, sort of become adults, and they also provide them a lot of support while they're in the process. You know, I mean, the goth culture, rave culture, environmental protest culture, you know, there's a lot of different types that they can choose from. The communities seem really important. We're very lucky in our outpatient program. We have lots of groups, and we're trying to pull them all in person, and that seems to be maybe a little bit more unique. A lot of people who have perhaps sought more mental health treatment have not had the group experience, and when they talk to us about their peer interactions and their socialization, it's very limited. It's pretty much online. It's not really face-to-face, so I'm thinking maybe that's really something that if we can beef up, if we can get more face-to-face interaction, as some people were suggesting, that might also help with this vision, help with just actually experiencing skills to move forward. So anyway, just thoughts. Thank you very much. Thank you. Hi, thank you for the talk. I had a question about sort of this general age group I think we see with this generation. I guess I first noticed it going through college. I think there's definitely more of an awareness, maybe a hyper-awareness of sort of racial, gender, sexuality sort of kind of like a more woke sort of culture. What are your thoughts in terms of like addressing those specifically from your psychodynamic or just general therapeutic perspective? Is it more just focusing on the commonalities of going through those phases of that early adulthood development versus understanding the specificities of each of those populations and trying to, I guess, address them in a more different way because I know with this age group right now, there's also this idea of finding like a therapist that sort of understands them either intuitively or through more like specialized education, life experiences and so forth. I'm not sure I'm completely understanding your question. Are you asking whether it is sometimes useful to send a young person who's experimenting within a certain domain to somebody like to a gender expert or to somebody who has specific experience and expertise in that domain? Yeah, I mean, I think referral is one way to kind of address those issues as they come up, right? But I think striking the balance between seeing the person as a general young adult that kind of goes through all these steps that we all need to go through versus validating and sort of understanding more particulars of their experience within racial, gender, other sort of sociological categories, if that makes sense. Sure, yeah, I mean, I think part of the experience of working with this age group, it's probably one of the benefits of being a child and adolescent and young adult clinician is that part of your task is just being open to like learning from the patients and hearing about whatever their experience is. In terms of identity exploration in these particular domains you're referencing, there is a lot of interesting research, particularly in the last few years that looks at the extra stress and pressure on young people who are exploring within minority domains. So exploring race and ethnicity or gender, particularly when there is a difference between the young person's emerging identities and the ones that are supported at home. There was some really interesting, like very quickly done research during the pandemic in terms of what happens with young people who were in college and who had found affinity with groups and just peers around gender and sexuality, particularly if those aspects of self had not been supported at home and what happened when they then had to return home and like give up those communities, some of which they were able to continue online, but they certainly had to give up the in-person sense of community and just a fair amount of research looking at the added stress of those kinds of identity explorations in the absence of support. So I think the therapist can be a very important source of validation and support for those young people for sure. Thank you. Any other questions, comments? No, I just, I always find it interesting to talk about the topic of emerging adulthood with clinicians because I think it's, for most of us, I think, to become a doctor, a psychologist, a social worker, any kind of mental health practitioner, I mean, we all had to sort of start pretty early. It just takes so many years. We kind of devoted your entire emerging adulthood to this goal. So I think for a lot of us, we were kind of on a pathway from a very early age. And I think that there are such people now, but I think it's, the vast majority of people are engaged in a lot more meandering and uncertainty. And I always find it interesting to do the work of relating to that kind of a struggle because I think it's different from what we personally went through, although we may have been meandering around in other domains. I think just having that certainty in terms of professional goals and the number of years that you just have to devote to it kind of keeps you on a certain trajectory. Yeah, and also, I mean, it just occurred to me that the statistic about jobs is that from graduation from college to 30, most people have an average of seven jobs. Most kids, that is. So there's a lot of moving around, but it's, you know, I mean, it is part of the search and some of them even end up going on a long trajectory which involves a lot of training, but it is a lot of meandering too and groping for what they wanna do and be. You know, sort of shedding identifications with, I mean, I'm just thinking of a young man who, a child of two physicians, who went, first thought about becoming a psychologist, then thought about becoming a newspaper writer, then thought about becoming a doctor, then thought about becoming a lawyer, and finally ended up becoming a horticulturalist. So there you go. There's all kinds of ways that things happen and some of them are really serendipity. Thank you. Well, very nice to meet all of you. Please read the book. Yeah.

Emerging Adulthood

Psychodynamic Approach

Developmental Phase

Role Experimentation

Identity Formation

Technological Advancements

Cultural Changes

Socioeconomic Groups

Generational Phenomenon

Identity Exploration

Therapeutic Approaches

Socio-cultural Changes