Abstract • 51

Adolescence is a difficult in-between age with a considerable discrepancy between physical and cognitive maturity. About 20% of healthy adolescents have behavioural difficulties. Those affected by severe diseases or undergoing high risk treatments may experience stress, pain, extreme frustration, depression, anger and strong interference in the growth and in the identity process. Their behaviour may also persist when they are off-treatment and in good health. Our investigation consisted in the interpretation of their writings and drawings and in psychodynamic interviews. This is an active listening technique, a patient centered method where the doctor is apparently only asking. Interpersonal communication skills require flexibility of style, in depth knowledge, persistence, ability to recognize and resolve barriers to communication. Questions are medically and psycho-socially oriented in order to obtain a complete scenario. Observation and interviews can be the basis for personalized therapy. During treatment the most disturbing, although rare facts that our experience revealed are fragmentation of the ego, psychotic access, fantasies about death and sexual identities. Family environment, psychological maladjustment, and behavioural difficulties between patient and parents when diagnosis is communicated and treatment is discussed are important factors. Complications and side effects may induce catastrophic feelings with fantasies. Adolescents with low levels of cognitive appraisal and social support are more threatened and their co** potential is lower. More than 40% of the off-treatment adolescents who underwent bone marrow transplantation we observed showed a high frequency of panic attacks, persisting psychological distress, self isolation, failure to engage in problem-solving efforts, low levels of personal resources concerning their futures, behavioural disengagement, and difficulties in co** with their past diseases, with stress and with their future as healthy adults.