In my private practice, I work with high school and college students. When I
have a new adolescent client starting treatment, I explain to their parents that
working with teenagers is different than working with adults.
The difference is that the teenager is usually not coming in voluntarily. Frequently, either their parents or the school have recommended treatment. Many times, there has been an inciden, or revelation that their child is struggling.
The exception to this rule is the stressed-out or anxious teenager.
Under the facade, of “everything is cool,” lurks extreme stress about getting into college or further advancement beyond high school.
Junior year of high school is notoriously stressful with standardized testing, GPA concerns and over zealous participation of extra curricular activities all in the quest for the perfect high school resume.
While the anxious teen might not request help, they readily accept it, unlike the troubled adolescents.
Therefore, building rapport with the adolescent patient takes longer to establish. Naturally, the teenager is very apprehensive about sharing his/her intimate concerns with a complete stranger, one that they probably had no hand in selecting.
As a matter of fact, on more than one occasion, the adolescent refused to show up.
At this point, the parents are exasperated and usually at their wit’s end. I gently explain to the parents, that it is still a good idea for them to come in and share their concerns.
Their presence accomplishes two goals – the parents can share their frustration with a caring understanding professional and it demonstrates to the teenager that the family is willing to make changes too.
It creates a message of solidarity…. “Even if you are not showing up … I love you and want to fix the problem between us.” Notice the use of the pronoun “us.” Pronouns plays a big role in communication; the use of the word “us” versus “you” sends a completely different message. The word “us” signals a cooperative approach versus identifying the child as the problem.
One of the keys to working with an obstinate teenager is to empower them. It might sound counter intuitive, however, underneath all the turmoil a power struggle is ensuing.
I instruct their parents to give them an option to help select their therapist. Once again, this forms a co-joining of parent and teen.
I suggest reviewing a few therapists’ profiles online or getting a trusted referral (Psychology Today has a listing of therapists in your area) and give their child a choice of meeting two or three. This way, the teenager is involved in the process and more likely to engage.
When a teen arrives for the first session, one of the first questions, I ask them is, “Are you here because you wanted to come or did your parents want you to come?”
They are usually surprised by that question. I explain that on many occasions, it is the parents who insisted that their child go to therapy and that it is normal for a them to be hesitant about sharing concerns with me.
In fact, their hesitancy demonstrates healthy boundaries.
I explain to them that the therapist/patient relationship is different from other relationships that they could have with a teacher, coach or friend.
The most important aspect of the relationship is that they feel emotionally safe with their therapist. If the patient doesn’t connect with the therapist, therapy will not be effective.
Numerous studies have demonstrated this single fact repeatedly – a positive therapist/patient relationship is a leading indicator for improved well-being and positive treatment outcomes.
So it’s important for teens to feel a connection and to listen to their inner voice. That exercise in itself, demonstrates to the adolescent patients that their voice is being heard and is valued.
Unhappy teen photo available from Shutterstock