Somatic symptoms are often an adolescent's way of showing his difficulties and asking for help and care. Adolescents need less medical care but more and more profound knowledge, reassurance and support, in order to become self-sufficient and mature persons. Therefore it is very important to offer to the adolescents an approach that considers not only somatic side, but that follows them as a whole, with a health operator able to recognize their needs and problems.

In the Adolescent Consultancy Service, an adolescentologist-paediatrician, a psychologist, a social worker, a health inspector help the adolescents from 11 to 18 years old age, who have somatic or psychological problems and relational difficulty with family, school and the friends.

My paper describes the case of a 12 1/2 year old boy, who often faints, mostly at school; his loss of consciousness turns in a little while and clears up on its own. Various neurological examinations, blood tests and a short period of hospitalisation failed in revealing any pathology, so I decided not to do any other examinations, but to simply try counselling the boy.

Indeed in a high percentage of adolescents, with two peaks at 13 and 18 years old age, we can notice the appearance of somatic symptoms, due to inability to tolerate, to construe and to communicate their emotional discomfort, revealed with headache, abdominal pains, fits of giddiness and syncope.

During the counselling L. may clarify his problems with a transverse analysis of his life: relationships with parents, friends, school fellows and teachers. It comes out that the adolescent is lonely, with an overly protective mother, outcast from his schoolfellows because of his childish and plain appearance. He doesn't like studying and he has serious learning problems; he is discouraged, depressed and often in a bad mood.

The loss of steadiness of the physical image and of the internalised parents to become independent and able to face facts, may have triggered a mechanism of anxiety-depression-somatisation.

Hence the interviews have been oriented towards helping him to recognize his own resources and to increase his independence and self-esteem. More care in studying results to an improvement in school so his teachers and school fellows accepted him more as well. He began to play sports and to study music, which he found particularly gratifying; he became more independent, sure of himself and able to make realistic plans for the future.

Now, after many months, he no longer faints, he has some friends and spends much time away from home with them and he has successfully finished his school year.

It is often difficult, source of anxiety and insecurity in a doctor to give up somatic approach, even if the interdisciplinary approach is the only one that can give lasting results in the adolescence.

R. Marinello: "The consultation with the adolescent: a clinical case". Paper presented at the First International Congress of Adolescentology, Assisi, Italy, October 22-24, 1993.

Key Words: Adolescence, Counselling, Somatisation, Loss of consciousness.

R. Marinello: Ricercatore I.M.E.P.A. - Servizio di Consulenza per Adolescenti - Settore Sanitario Materno Infantile e dell'Età Evolutiva - U.S.S.L. 21 - Via Fratelli Bandiera, 10 - 35100 Padova - Italy.