How does anyone survive the delusional thinking of adolescence? Many of us may shudder to remember our own grandiose, knuckleheaded, or outright dangerous escapades, struggling even now to find a mildly coherent explanation beyond, “It seemed like a fun idea at the time.” Some parents, perhaps recalling their own close calls with imagined invincibility, fear all the more for their kids. Though they might know better than to expect a sensible answer, they’ll ask their teen in dismay, “What were you thinking?” And following a particularly flagrant or risky demonstration of teen-think—a totaled car, sexts shared far and wide, a stolen traffic cone carved into a bong, a jump off of a bridge into a culvert on a bicycle—the therapist gets the call: Help my kid get back in touch with reality!
It’s easy to understand such parental concern, especially when most therapy traditions maintain that healthy functioning requires us to see reality as it is (whatever that means)—and since teens often don’t. But what if a key sign of adolescent health is, instead, an “optimal delusionality”? What would happen if therapists stopped looking to modify or work around the unique structure and functioning of the teenage brain—delusional though it may be at times—and did more to intentionally foster and celebrate the creative and generative aspects of that adolescent’s alternative worldview?
In Useful Delusions: The Power and Paradox of the Self-Deceiving Brain, Shankar Vedantam and Bill Mesler tell us that delusions can serve a function for individuals, societies, and cultures. How might this idea apply to work with our adolescent clients? What would change in the way we practice if we attended more to the functionality of their expansiveness, choosing to join intentionally in curious conversations with them? In this light, teen-think isn’t simply a problem to be solved by therapy, but a developmentally essential antecedent to a complex and integrated adult identity. In other words, to grow up whole, teenagers and young adults first have to be optimally delusional.
What Is Teen-Think?
Teen-think (most easily identified by adults’ reactions to its presence) involves risk-taking, unfathomable emotional intensity, and an unquenchable need for belonging. Because the adolescent brain has too many neurons, it’s not the most efficient machine. The thinking prefrontal cortex is no match for the emotional limbic system. Actions often precede reflection. And as we all know, emotional reasoning reigns. To achieve a more streamlined adult brain, adolescents and young adults need new experiences. Deep relationships with people of all ages (not just peers), novelty, passion, trial and (sometimes colossal) error result in neuronal pruning; synaptic connections become stronger, faster, and, if all goes well, better mediated by the thinking brain. Adolescent delusions provide the fuel for all that exploring and experiencing.
Yet it’s also helpful to understand that delusions serve some need beyond this biological process—these delusions do something for our clients. As adults and therapists, we may react in horror when, for example, a delusion of invincibility manifests in risk-taking. But once we get past the initial shock, we’d do well to wonder why. What does this delusion do for them?
Studies show that adolescents aren’t oblivious to danger: they weigh the available information about the risk of a given plan reasonably well. But they also crave life experience. After all, how can anyone really learn what’s possible without some experimentation? Taking chances is surely one way, however misguided, to achieve this. Teens have a much higher tolerance for uncertainty and ambiguity than we adults do; they’re more willing to take a risk that offers a big payoff, even without much assurance that they’ll actually be successful—and when the downside could be fatal.
What Are They Thinking?
Mike’s mother is worried because he’s exerting minimal effort in school, preferring to spend every waking minute doing what he loves: playing basketball. She wants him to get his head out of the clouds. A sinewy 16-year-old boy, all elbows and knees, he sprawls in his chair, telling me (Martha) she’s right about one thing: he has big dreams. He’s confident that his passion and hard work will lead him to basketball stardom. Indeed, to prove his point, he shares with me a Zoom view of his bookcase, brimming with tidy rows of trophies and medals, nary a book on a shelf.
Also in a struggle with her parents over reality, Josie is a willowy 14-year-old, who, in just a couple of days, garnered over 30,000 TikTok followers after posting a 15-second sashay down the hallway outside her family’s apartment. Josie believes—perhaps looking at this initial evidence as proof—that she’d already be well on the way to a life of wealth and fame if only her Luddite father would stop trying to shut down her TikTok account (which, truth be told, he can’t seem to figure out how to do). Like many teens, Josie feels her parents are overprotective; she’s also more confined because of the pandemic. How could she not be over the moon with her success in becoming a worldwide influencer at such a young age?
At the other extreme, many of our more depressed and suicidal clients seem to be burdened by too much reality; their capacity for delusion is stymied by the “real world.” Indeed, optimal delusionality appears to buffer our young clients against hopelessness and despair. It motivates them, and when it evaporates, they have a harder time holding onto hope.
Take Maddie, a college junior who wears her 4.0 grade-point average as a badge of honor. She aspires to become a human rights lawyer. Yet when the presidential campaign was in full swing, she had panic attacks for the first time. Amid all the turmoil in the country, she felt responsible; she wasn’t doing enough. She’d imagined that by now she’d be a leader on campus standing up for social and racial justice. Instead, she’s having trouble getting out of bed. The real world, with its demands and its pains, has brought her to her knees.
Whether they’re putting their lives in possible peril, feeling emotions deeply and irrationally, rebelling at a fevered pitch against the expectations of the adult world, or struggling with identity confusion, the teens we work with deserve our particular empathic awareness. We need to be willing to suspend disbelief and join with them in wild exploration. The urge to “yes, but” is strong in adults. Try to imagine, if only for a while, that dreams come true: what could life be like for an NBA star, a TikTok phenom, or the next Amal Clooney?
To jump on board and fully grasp the meaning and utility of expansive dreams, it’s helpful first to know about the four kinds of normative adolescent delusions that we typically encounter in therapy.
1. The Delusion of Possible Selves
Mike, the NBA hopeful, and Josie, the TikTok microinfluencer, are imagining themselves with great optimism—and notably little parental endorsement—into an uncertain future. They’re a step closer to reality than five-year-olds who want to be superheroes, astronauts, and presidents, but their ambitions, arguably, are still poorly aligned with their likely futures.
Many adults, including those who tell their kid, “You can do anything you set your mind to,” view the Possible Selves delusion as a worrisome focus of time and effort. Thinking less about what it takes to become a decent point guard or to curate a TikTok presence, they fret instead over the likelihood of later disappointment and danger “if this is all my child thinks about now.”
And so, part of our job, ostensibly, is to help these teens with their irrationality while redirecting their attention to safer and more certain pursuits. From this perspective, the work of therapy is also intended to help adolescents let go of how they view themselves in the world in favor of some more grounded, grown-up standard.
Yet we also help parents see the other side. It can de-escalate struggles at home when they recognize that heightened conflict is an indicator of the passion that infuses the Possible Selves delusion. When teens believe so confidently that they’ll become, for example, NBA stars, and are willing to fight for their dreams, it can actually help clarify the difference between what they want for themselves and any differing or opposing parental agendas. In this way, it’s likely that such delusions provide the seeds of a distinct adolescent selfhood.
Compared with teens who’ve had to foreclose on identity development because of trauma, oppression, or a lack of discernible options, these clients hold remarkable visions for a life yet unlived. Their capacity for commitment to an imagined identity seems an advantageous starting point for therapy. In another light, Possible Selves is a useful metaphor for becoming, for finding the thread that could connect a child in a small, cluttered bedroom to the vast, vibrant, dancing, all-net-three-pointer world.
2. The Delusion of the Personal Fable
The personal fable was first described by child psychologist David Elkind in 1967, but it’s a concept that withstands the test of time. Many adolescents and emerging adults become so fascinated with the special way their own minds and hearts perceive things that they can’t imagine anyone else grasping this lived experience as they do.
I (Martha) recall a conversation with a young adolescent client who was sobbing about how terrible she felt getting dumped by the boy she liked. When I nodded knowingly about how devastating this must have felt, she wheeled around and snapped, “What do you know about this? You’ve never been in love!” I couldn’t help laughing, though I’m still sorry that I did. Was there really no love when dinosaurs roamed the earth? I wish I’d simply said something like, “I’ve certainly never felt exactly as you do, so I want to hear about what it’s like for you.”
An important part of the Personal Fable is the attendant experience of invulnerability. Uniqueness can sprinkle a kind of superpower over the adolescent with Personal Fable delusions. The thinking goes something like this: if no one has ever experienced life as I do, then the consequences that may generally befall others won’t necessarily apply to me. In this way, Mike reasons, “Just because most guys with NBA dreams don’t make it to the big time, some do, right? So why not me?”
Such egocentrism can be frustrating and worrisome to adults who are impatient for their teens to think more about the consequences of their actions and how they may affect others. But the Personal Fable can become a centerpiece of adolescent psychotherapy; indeed, we’d do well to be as fascinated with teens’ experiences as they are. And our young clients’ belief in their originality can actually help them become more resilient in the face of other kinds of challenges and self-doubts.
For example, Mike and I have engaged in epic games of Nerf basketball. In a game of HORSE, he’s diabolically clever, setting up impossible shots for me to replicate. These sweaty therapy sessions lead me to wonder, “How do we translate your amazing creativity in shooting hoops to the school stuff you need to do?” We talk about how point guards learn to see the whole court at once and brainstorm ways he could try that big-picture thinking in other parts of his life.
Mike’s extravagant self-confidence and this new perspective allow him to think more expansively about his problem with schoolwork. He says, “I may not be good at math, but I’m pretty great at basketball.” Where he might have felt small, in this conversation, he’s as big as Shaq. Along with my respect and curiosity, that bit of delusionality illuminates a path toward self-compassion and self-esteem. His Personal Fable buffers him from feeling brought down by poor grades, and learning to “envision the whole court” equips him with a more courageous and creative approach toward his algebra homework.
But while the Personal Fable can be a motivating force for some young people, it has its pitfalls. Take my (Kevin’s) client Maddie: in addition to her big dreams, she’s a perfectionist’s perfectionist. She’s long believed that with hard work and determination, she really can do anything she wants with her life. Yet maintaining relentlessly high standards for herself has resulted not in a healthy sense of accomplishment, but in overwhelm and disillusionment. She spends almost all her waking hours buried in her books and obsessively worrying about every assignment. The narrowing gap between the “real world” and her exacting expectations exhausts and isolates her. Maddie’s Personal Fable has become a burden, leaving her anxious and depressed.
When I hear her mournful disappointment, I find myself both saddened at her plight and slightly irritated. I think to myself, “Well what did you expect would happen? You actually believed you could save the world single-handedly?”
Instead of invalidating her, however, I work to unpack both the hopefulness in her aspirations and the genuine grief she’s feeling as she realizes that, in their current form, her dreams are not attainable today. She’s taken on too much for any mortal. Yet I can recognize and admire the generous spirit that resides within her Personal Fable. I know that Maddie’s big heart and commitment to social justice are important to her, so I ask, “What can you do today, in a concrete way, that reflects these values?”
This conversation opens up more doors that I expected. Focusing on her immediate environment gives Maddie a sense of empowerment. She doesn’t feel as helpless and overwhelmed when we keep it local. Our work together leads us to find ways to preserve the essence of that grand vision for her identity and future while venturing forward on a more manageable scale. She’s begun by collaborating with area restaurants to distribute meals to families and people in need. She didn’t organize the program herself, and it’s not a big commitment, but she acknowledges that it feels good to see the gratitude on people’s faces.
In recent sessions, Maddie has begun pondering the idea that maybe “I can still have it all—just not all at once.” As I see her slowly beginning to take hold of her life again, I think these months of therapy may have moved her from oppressive reality toward a more optimal delusionality. And I think she’s a remarkable kid. It’s actually not hard for me to imagine her accomplishing great things, all in due time.
3. The Delusion of the Imaginary Audience
The Imaginary Audience accompanies the Personal Fable. When adolescents become preoccupied with the specialness of their thoughts and feelings, they often find it increasingly difficult to imagine that others aren’t similarly engaged in observing them. Indeed, most of us can probably remember a day (or 50) in early adolescence when leaving the house with a bad haircut, acne, or the wrong clothes felt like being forced onto a brightly lit stage. Although terrifying at times, the Imaginary Audience can help young people figure out how they want to be in the world, to develop empathy and connection with others, and to learn some social skills. And because it’s imaginary, the potential for psychic harm is transient: most of us gratefully part ways with that level of solipsism in just a few years.
Curiously, at some point following Jim Carrey’s performance in The Truman Show, therapists began identifying a psychological condition called “The Truman Show delusion,” in which young people sincerely believed they were actors in front of a hidden camera. In a less extreme vein, more adolescent and emerging adult clients in recent years have been talking about the surreal sensation of life as performance. While this awareness is not as creepy as that depicted in The Truman Show, they can still easily imagine that a huge audience could be watching them. For some of these young people, the experience of adolescence itself blurs the line between reality and enactment. You may even discover you’re a little delusional, too, when you find yourself both being the therapist and playing the part of the therapist in an emotionally charged session.
And, of course, cameras are everywhere for Gen Z kids, who have, at their fingertips, thousands of pictures and videos taken by parents and friends and so, so many selfies amply documenting their waking (and even sometimes sleeping) moments, starting at birth. Literally billions of these images are uploaded to social-networking sites every day. Now that real viewers have crowded into this delusion, we need to address a new therapeutic quandary: how imaginary is the Imaginary Audience, exactly?
Notably, one of the many challenging aspects of therapy with aspiring social media star Josie is her large following. Everyone really is watching her! It can be disorienting and anxiety-provoking to treat teens whose delusions have become real. Though it’s true, of course, that the objectifying voice of an Imaginary Audience can sometimes be critical and shaming, it’s not as ugly as the actual reactions of snark, lewdness, and slut-shaming that Josie is now sorting through (along with all the compliments, lust, and envy) in response to her brief video.
Being at the center of the universe is supposed to be an adolescent fantasy, not an actual onslaught of indelible judgments. If Josie could have the optimal delusion of an Imaginary Audience, she’d gradually learn to see herself through others’ eyes and be confident she’d be the star as long as she needed that limelight. Instead of this freedom, however, she’s found herself in a reinforcing cycle: she has to keep posting TikTok videos or risk abandonment and rejection.
Josie doesn’t want to contemplate how she’ll feel if her followers lose interest and wander off to view one of the other billions of TikToks posted daily. “I think it’ll make me miserable,” she sighs. “But you know, maybe that won’t happen.” Well, maybe it won’t; let’s imagine that, too.
And now, as maybe I (Martha) should have expected, Josie has admitted to food-restricting. She’s lost just a few pounds, but she’s fighting expectations to eat regularly. It’s time to bring a nutritionist onto the team. I’m not simply blaming TikTok for Josie’s emerging eating disorder (plenty of young people had eating disorders before social media complicated things), but still, it’s tough to ignore the connection. Truly, I was more confident about what to do when the scrutiny and voices were just in her head.
Now that her audience is real, Josie and I have begun talking about the responsibility that comes along with it. She doesn’t want to encourage other girls to stop eating; she confesses that some of the more disparaging online commentary has actually brought her to tears. And with my curiosity and encouragement, we’re looking at the more body-positive branch of TikTok for inspiration. It’s really hard being an isolated young teen in a pandemic, and for Josie, social media are at once lifelines and quicksand. My own necessary delusion is that I can help Josie decide that her worth can’t be weighed in pounds or followers. I just wish it all wasn’t so real: with an Imaginary Audience, the only “like” that matters is Josie’s.
4. The Delusion of Boundless Freedom
If the Possible Selves delusion tells teens they can be anything, the delusion of Boundless Freedom tells them that life would be richly rewarding if they could do whatever they wanted. If it weren’t for the constraints and lack of imagination of parents and other adults, adolescents operating within this delusion envision themselves doing everything. Even when there’s plenty of evidence to the contrary, the world really should be their oyster. A belief in Boundless Freedom does away with all that second guessing and doubting that adults are famous for. It makes everything possible, consequences be damned.
As a gender-nonbinary adolescent, Max envisioned college as a place to finally be themselves and to find a community. Now a college freshman, they’re on their own for the first time, and they love it. They’re making friends and enjoying life. Max comes to therapy ambivalently, realizing that, although college life is fun, they’re not getting their schoolwork done in a timely fashion. They’re a little anxious, but their parents’ nagging, at least initially, is a greater problem for them than their Olympics-level procrastination. They describe the number of activities to which they’ve committed as though they’ve forgotten about this thing called time. All these exciting plates are spinning right now; they’ll get to the mundane stuff later. In a world of seemingly endless possibilities, why limit themselves?
I (Kevin) see why they dither over doing the boring stuff. I try to lean into their world of possibilities and to suspend my own stultifying adult belief in the limits of time and space. A part of me can join in their delusion of Boundless Freedom as we discuss their five classes, the drama club, the coding club, the part-time job, the new group of friends, and now, too, the travel schedule for the ultimate frisbee team. Max is wonderfully enthusiastic; I can get caught up in this thrill and novelty of university life. A simple “tell me more” from me and we’re off in a whirlwind wrapped in exhilaration. I really mean it when I smile and say, “I’m so glad you’re taking advantage of all these opportunities! You sound like you’re really finding your place and a sense of belonging here.”
Yet when our reverie ends, I remember the calendar and the clock, wondering when or how they’re going to do all of this. I ask, “So if everything is going so well, why do you think you’re anxious? What’s the anxiety trying to tell you?”
As we continue working together, Max begins to connect their anxiety to the problem of finite time and a growing pressure to establish priorities. They want all that college has to offer, but maybe all these activities aren’t of equal importance to them. They come to realize how their deeper needs and the all-too-common FOMO (fear of missing out) collide with the limits of time and space. Exploring this FOMO and understanding their need to belong and feel accepted on campus help Max get a better sense of what they value most; passing classes and staying in school are actually high on the list. With my encouragement, they’re now seeing the potential for compromise. Plenty of living space exists between boundless freedom and the limits of mortal existence.
What can therapists do to embrace and enrich the emerging sense of self that grows alongside these necessary delusions?
Hold Hope. Therapists hold hope for clients and the therapy process: hope that emotional wounds can heal, that unconditional acceptance can help our adolescent clients become themselves more fully, that some small good will come from each encounter. With these adolescent clients, holding hope may be the hardest task required of us. When our client’s despair is too deep, their pain too immense, or their grandiosity too dangerous, we must hold the hope for both of us. We keep vigil for the developing person, believing that our presence—and, yes, our own delusions about the power of this relationship—will lead to a connection both profound and transformative.
Hold Sorrow. Therapy with teens and emerging adults is, in some part, grief work. We tend to evaluate adolescent experience through the lens of the necessity of growing up. Every developmental attainment, each sign of maturation, brings with it the loss of what was dear about an earlier stage of life. Leaving behind necessary delusions can bring significant diminishment and sadness. We can do a disservice to our adolescent clients if we forget how much a person has to give up to grow up.
Value Safety. Of course, we don’t need to enter into a teen’s delusional system so deeply that we throw all caution to the wind. Our adolescent and young adult clients come to us because something isn’t working (although assessments of the problem may vary widely). Parents worry. Teachers express concern. We may think to ourselves, “This sounds nuts.” And often the adult perspective is spot on. Sometimes the danger is real, and we have to intervene to keep kids safe. Drinking and driving, heavy drug use, suicidal thinking, disordered eating, and self-harm are prevalent and serious problems. Therapists do well to engage in harm-reduction strategies, but clinical and ethical judgment must always prevail.
Most of the time, though, it’s not a life-or-death problem: it’s the struggle of a kid trying to figure out how the world works. So as part of the safety assessment, try to grasp how the struggle, the delusion, and the worrisome behavior coalesce to meet a need, and then collaborate to answer the question: how can this need be met in an objectively safer way?
Attend to the Storyteller, Not the Story. Some of our young clients’ expansive fantasies might suggest that they’re unaffected by the world around them. On the contrary, many of these kids are buckling under the weight of expectation, uncertainty, disappointment, crushing sorrow, institutional racism, sexism, heterosexism, and cascading traumatic losses. Their futures are, indeed, uncertain.
It’s easy for our adult brains to get distracted by adolescent ideas that appear to be patently ridiculous, but focusing on the storyteller can help us make better sense of the story. Maintaining our unflinching empathy, getting into their world, and trying to see the meaning and function of these delusions give us a better grasp of what our clients are going through and help us make sense of their pain. We shouldn’t get so absorbed by the content of the dreams that we lose sight of the dreamer.
Don’t Forget to Play. We can sometimes forget how near to childhood our adolescent clients are. When we let go of our adult expectations, we begin to see how the delusions of adolescence and emerging adulthood are essentially playful. The fantasy play of childhood takes a new shape now; adolescents bring along the expansive fun of imagined possibility and start to try it out in real life. It’s revelatory, meaningful, and developmentally appropriate. Playing cards, shooting hoops, or engaging in collaborative art projects with teen clients can help build connections and encourage them to open up.
Play also means getting into their ideas, their obsessions, and their dreams. Sometimes you have to travel to the Marvel Universe with them. Find out what your young clients are into, and ask them to show and tell you all about it. It’s much easier for you to enter playfully into their wildly optimistic worlds than for them to button up and act the part of an adult. Go ahead and have some fun with these kids.
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Maddie and I (Kevin) have continued the battle royale over her perfectionism, but last week she loafed a while with friends on a sunny day, and I see her growing in her capacity for self-compassion. She’s begun letting the smaller successes count, too. I see glimmers of hope and optimal delusionality taking hold. The anxiety and depression return like the tide, but she’s daring to dream again, too.
Indeed, last week, Maddie appeared for our teletherapy session beaming as brightly as I’ve seen her since we started meeting. I commented on her sunnier mood, and she paused a moment before explaining, “I think I may have figured something out. You know that Ruth Bader Ginsburg was almost 90 when she died? Do you realize that gives me 70 more years to fix the planet you people broke?” My look of astonishment brought a grin to her face. As we laughed together, I felt a surge of joy knowing the world was a better place with brave Maddie in it, delusions and all.
Martha Straus, PhD, a professor in the Department of Clinical Psychology at Antioch University New England, is the author of Treating Traumatized Adolescents: Development, Attachment, and the Therapeutic Relationship and, most recently, coauthor of the third edition of The Lost Art of Listening: How Learning to Listen Can Improve Relationships.
Kevin McKenzie is a doctoral candidate in the Department of Clinical Psychology at Antioch University New England. His work and training have focused on integrating developmental and interpersonal perspectives in therapy with adults and emerging adults.
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