One obvious fallout from excessive shielding is that the young adult may choose to do everything in their power to demonstrate they can look after themselves. This form of rebellion toward authority, designed to establish separation, can easily manifest as rejection of medical advice. Thus, the clinician may witness a period of time during which the patient must see for themselves the results of noncompliance with treatment. This leaves the clinician in the ironic position of having medical recommendations, targeted to assist the young adult in feeling normal, being obstructed by a rebellious response that, by nature, feels normal to the young adult.
The clinician may, however, find the young adult receptive to indicators of autonomy that promote emancipation from parental influence. For example, a transition clinic can enforce a policy requiring the young adult to attend the clinical examination alone, without parental presence. Self-advocacy skills can also be taught. Finally, tips for developing independent living skills can be conveyed. This is particularly important for patients who find themselves in a milieu of violence and/or substance abuse.
Establishment of peer relationships—Young adults are developing relationships outside of the family, and their self-esteem is often linked to an open expression of thoughts and feelings that are accepted by peers. Consequently, the young adult may experience the struggle, and perhaps the exhilaration, of creating an explicit identity through the collapse of certain beliefs that previously provided stabilization and comfort. For this reason, the importance of providing opportunities for establishing positive peer relationships in social environments that are inclusive and accepting of diversity cannot be overstated.
The clinician may witness a period of time during which the patient must see for themselves the results of noncompliance with treatment. This leaves the clinician in the ironic position of having medical recommendations, targeted to assist the young adult in feeling normal, being obstructed by a rebellious response that, by nature, feels normal to the young adult.
The young adult patient may also have the added worry about how best to prove that physical limitations from symptomatology can be withstood. The possibility of death or severe disability from disease complications may invoke profound feelings of isolation precisely at a time when one is typically striving for contact and belongingness. If this is the case, the clinician can counter by encouraging socialization with others, perhaps through social support groups that offer exposure to others dealing with a similar condition.
