Bailey’s life is in a state of flux. Aged 12 and in the first year of high school, he is in the throes of puberty, with all the physical, emotional and cognitive changes it brings. His parents split up last year; now he lives with his dad and older sister in a rented house during the week, staying with mum and her new partner at weekends. His friendship group from primary school has drifted apart; he tells me that although he’s made some solid new friendships in high school, he often feels lonely. Nonetheless, Bailey seemed to be coping pretty well with these different challenges – until he was diagnosed with diabetes a few months ago.

He finds the new regime of monitoring his blood sugar levels, keeping track of what he eats and injecting himself with insulin, both exhausting and anxiety-provoking. After a second diabetic collapse and overnight hospital admission, Bailey admitted to a nurse that he felt he wasn’t coping well with looking after himself and that sometimes he thought he’d rather ‘not be here’ than have to keep going with things as they are. Some days he was choosing not to take his insulin so that he could tell his dad he didn’t feel well and get a day off school. A referral was made to the school counselling service, and Bailey arrived at our therapy room.

Some of the changes Bailey is experiencing are shared by many young people of his age living in the UK: making the transition from primary to secondary education, going through puberty, navigating the landscape of shifting allegiances, and trying to find one’s place in the social order. Other changes that Bailey faces are less universal, but nonetheless fairly prevalent – around a third of children and young people will experience parental separation,1 and moving home (whether or not it’s connected with the breakdown of a parental relationship) is also pretty common. Becoming diabetic in childhood is, thankfully, less usual. But what all of Bailey’s changes seem to have in common is that they are causing him significant anxiety, enough to disrupt his day-to-day functioning and sense of being able to cope.

That Bailey is feeling anxious about the changes in his life is not very surprising; after all, he’s getting his head around so many new things: a new school and new relationships; a new and ever-changing body (courtesy of puberty); a new home, a new parental figure (in the form of mum’s partner) and new family living arrangements; and finally, a new health condition, which will affect him for the rest of his life. But why is it that Bailey is having trouble with anxiety in particular, rather than other emotions such as rage, shame or disgust? In this article, I want to share some theoretical ideas – some tools for thinking, many drawn from social anthropology – about change and transition and the anxieties they naturally evoke.

The anatomy of change and transition

Arnold Van Gennep was an anthropologist who studied tribal communities in Africa around the turn of the 20th century. One of his great insights was that transitions in general are experienced by humans as anxiety provoking, even when the changes they herald are welcome and looked forward to. For example, getting married and becoming a parent are (in many contexts) changes that are consciously chosen and usually accompanied by feelings of excitement and anticipation. Yet it’s also normal for feelings of anxiety or disorientation to arise. In Van Gennep’s classic text, The Rites of Passage,2 he described the various transition rituals he had observed across the communities he visited, and noted that all of them seemed to be geared towards containing anxieties about change. Whether we are thinking about weddings, funerals or baby showers, passage rituals help to ‘protect the vulnerable individuals who are passing through them, and to give the others, the witnesses, a way of behaving in the presence of the instability in the social group that these changes would otherwise create’.3

Van Gennep’s other major insight was that rite of passage rituals shared a common three-act structure. Whether they were designed to support childbirth, puberty, betrothal, marriage or death (or any of the other ‘life-crises’ that can happen in the course of a human existence, like getting sick), the rituals he studied all seemed to be made up of three phases. Van Gennep referred to these as (1) separation, (2) liminaire (this and its English cousin ‘liminal’ are descendants of the Latin root word limen, meaning ‘threshold’), and (3) incorporation. In the rituals Van Gennep was describing, separation and incorporation were about the removal and eventual return of the person undergoing the rite of passage from their social group. For example, during circumcision rites, Ndembu boys in Zambia are physically isolated from the rest of their tribe and return to the group once their wounds have healed. The middle, liminal phase of the rite of passage (the ‘liminaire’) is where the transition itself is located, facilitated by its own specific rituals.

William Bridges’ book, Transitions,4 draws on Van Gennep’s insights, and updates them for a contemporary audience. Bridges makes a useful distinction between transition and change: ‘…change is situational. Transition, on the other hand, is psychological. It is [...] the inner reorientation and self-definition that you have to go through in order to incorporate any [...] changes into your life’4. He suggests that it’s not so much changes that cause difficulty, but rather the transitions that need to go with them – particularly because rite of passage rituals are much less common in our Westernised cultures than they used to be. Without social rituals, the internal experience of transition has to be navigated by an individual in isolation. It doesn’t matter how many changes we try to make in our lives; if we don’t actually manage to get through the psychological process of transition, the ‘situational’ change won’t stick. As Bridges puts it, ‘…without a transition, a change is just a rearrangement of the furniture. Unless transition happens, the change won’t work, because it doesn’t “take”’.4

Like Van Gennep, Bridges talks about a three-act structure for transitions, and I’ve found his system useful for understanding some of the difficulties that children, young people and all of us, can have with them, because each phase (the ending, the neutral zone, and the new beginning) presents its own challenges. Let’s have a look at each phase in turn and consider how it might impact our young clients. 

An ending

The first phase of a transition is the end of the old thing, or whatever is being left behind. As we know, endings always entail losses, and loss can evoke a wide range of feelings: shock, disbelief, disorientation, yearning for the lost person or thing, anger or even rage, hopelessness and despair. How we experience these feelings and are able to work through them will depend on our previous experiences with loss, and particularly how losses were supported in our earliest attachment relationships. Those of us fortunate enough to have experienced secure attachments will probably have an easier time processing endings and losses than those of us whose earliest relationships produced avoidant, ambivalent or disorganised attachment styles and behaviours. Working in a high school, I’m always interested to see how young people approach the ends of lessons, the school day, the school term and the school year – and finally the end of school itself; the transition out of the education system and into the wider world. Observing how young people cope with letting go of things helps me to think about their attachment relationships and how they might experience endings – of individual sessions and of the therapeutic relationship – with me.

A neutral zone

The ‘neutral zone’ in a transition (what Van Gennep called the ‘liminaire’) brings its own special flavour of difficulty. Here, I think the major challenge is tolerating uncertainty – particularly in situations where we don’t know how long the neutral zone will last. For young people in schools, neutral zones crop up in the time between sitting exams and finding out the results, or in situations where something has gone wrong – there’s been a fight, a student has been deemed disruptive and asked to leave the classroom, or a nasty rumour has been spread – and an investigation needs to happen. In situations such as these, a young person may have to tolerate an open-ended neutral zone where they don’t know yet what the consequences will be for them, or how quickly they will find out.

In order to tolerate uncertainty, we have to develop what John Keats called negative capability, ‘...when a man is capable of being in uncertainties, mysteries, doubts without any irritable reaching after fact and reason’.5 Sitting with uncertainty is doubtless something that all of us therapists were encouraged to read and think about during our training, precisely because it is not an innate ability. Learning to tolerate appropriate silence in clinical work, for example, is a skill that many therapists in training can find difficult and have to practise.

Beyond the considerable challenges of tolerating uncertainty, the neutral zone can be difficult for a second reason. Not only is the uncertainty inherent in that space uncomfortable, but we may also have to deal with negative projections from others when we are sitting in it. The work of another social anthropologist, Mary Douglas, is helpful in understanding this. In her book, Purity and Danger,6 Douglas describes how human thinking is organised around classification – our thought processes tend towards putting things, people and ideas into mental boxes. We don’t know where we stand with things that don’t fit neatly into these boxes, so they can make us feel unsafe. For that reason, ‘Danger lies in transitional states, simply because transition is neither one state nor the next, it is indefinable. The person who must pass from one to another is himself in danger and emanates danger to others’.6 In traditional rite of passage rituals, people in the neutral zone were often considered polluting and liable to behave in dangerous or unpredictable ways – hence the practice of removing them to a different location for the duration of the transition process.

Douglas’ insight adds to our understanding of why rituals are so important during transitions, because of their ability to symbolically contain feelings of anxiety.

At the micro level, I’m thinking about the ritual of putting a ‘Do not disturb’ sign on the therapy room door at the start of a session. I encourage children and young people to do that for themselves, rather than me taking charge of it, because when it becomes a ritual, I think it can help my young clients to internally acknowledge and adjust to the threshold between the ‘ordinary’ landscape of school and the rather different culture and atmosphere of the therapeutic space.

On a larger scale, I think the transition from primary to secondary school is a place where we are actually doing rather better than we used to, in terms of using ritual as a support. My own experience during the 1980s was a quick tour of the ‘big school’ and a stern talking-to from my soon-to-be head teacher. In contrast, children about to come into the first year at the secondary school where I work, have a three-day transition visit, going to a wide range of lessons and meeting a number of members of staff, as well as being buddied by senior students. There are ‘enhanced transition’ programmes for children who need extra support, and events for all parents and carers during both the three-day visit and towards the end of their child’s first month at high school. Thankfully, extended transition visits are now the norm in schools in Scotland.

A new beginning

Having survived the painful feelings that can be evoked by endings and loss, and after navigating the ambiguity and uncertainty of the neutral zone, the final stage of the transition process involves making a new beginning. Here, I think the major challenge lies in stepping over the threshold into whatever comes next. Even when a new state of affairs is looked forward to with excitement and eager anticipation, the act of crossing from the known of the ‘now’ into the unknown of the future can provoke huge anxiety. I want to introduce one final concept here, which I have found especially useful in making sense of children and young people’s experiences of transitions in school.

The German language has all sorts of useful words for things that English doesn’t; Schwellenangst is German for ‘fear of a threshold’, and it refers to the stomach-tugging twinge of doubt that we can feel as we enter a new space or experience. I find Schwellenangst to be particularly helpful in thinking about what is known as ‘school refusal’ – where children or young people become so anxious about school that they resist all efforts to persuade them into the building. In other cases, getting into school itself is possible, but serious Schwellenangst arises when young people are asked to go into classes. Some young people seem to spend interminable amounts of time in unused classrooms and other ‘holding spaces’, while the perplexed adults around them try to figure out how to get these apparently ‘difficult’ pupils to comply with the seemingly ordinary demands of the school environment. I don’t have any easy answers for how to work with Schwellenangst – each case is unique and will need careful thought. But perhaps just acknowledging that it is a real, shared experience – and helping children, young people and their supporting adults to name it – is a good-enough place to start.

So what about Bailey’s transitions? We worked together for some months, gently noticing how much upheaval he had experienced over the previous year, naming the various endings, changes and losses. We acknowledged how much it had cost him to persevere with ‘business as usual’ through his parents’ separation, the school transition and changes in his friendships. We talked about the challenges of adolescence, normalising some of his fears about being perceived as ‘weird’, and observing that he was not alone in struggling with his changing body and identity. We spent time examining Bailey’s feelings about his diabetes, and making friends with the underlying anxiety that had taken up semi-permanent residence in his gut. We talked about how anxious feelings are directly connected to our human survival instincts and how Bailey might usefully use the symptoms of anxiety to know when he needed a bit more support from those around him, particularly in relation to managing his diabetes. We didn’t ‘cure’ Bailey of his anxious feelings, but gradually he was able to make better sense of his recent experiences and start to integrate them into his life story. There was certainly some Schwellenangst around the thought of giving up his weekly therapy session, but eventually Bailey could put his new tools for thinking about change to good use, and head out into the unknown future.

Sarah Haywood works as a school-based clinician and trainer for Place2Be. She is also a lecturer in Art Psychotherapy at Queen Margaret University, Edinburgh.


1 YoungMinds. Adressing adversity. media/2715/ym-addressingadversity-book-web-2.pdf (accessed 5 October 2019).
2 Van Gennep A. The rites of passage. Chicago: The University of Chicago Press; 1960.
3 Beels CC. Psychotherapy as a rite of passage. Family Process 2007; 46(4): 421–436.
4 Bridges W. Transitions: making sense of life’s changes (revised 25th anniversary edition). Boston MA: Da Capo Press; 2004.
5 Letter from John Keats to George and Tom Keats (no45). In Holloway R. Waiting for the last bus: reflections on life and death. Edinburgh: Canongate Books; 2018 (p30).
6 Douglas M. Purity and danger: an analysis of the concepts of pollution and taboo. London: Routledge; 1966.