Working with teenagers and young adults in therapy is exhilarating, frustrating, exciting and daunting. They don’t always wish to be in treatment but most generally warm up to the idea. They are curious about the non-parent adult who is asking unusual questions and seeking a connection for the purpose of potentially assisting them in being happier and healthier. They are generally willing to be verbal, somewhat introspective, and often quite inquisitive. They are on the cutting edge with the latest trends and technology, often keeping us therapists informed but feeling slightly behind. By the latter part of the teenage years, most are very eagerly, albeit somewhat anxiously, looking to the time when they can be more independent adults.
In collaborating with teens at this stage, it can sometimes be helpful to remember some of the pivotal points from similar stages in our own earlier lives. We have our theories, our knowledge of developmental stages, and our trendy tricks of the trade to employ with this age group, but tapping into our own memories of yesteryear can sometimes help us to be more empathic. Reflecting back on my own launch into adulthood has permitted me a renewed appreciation for that stage of life, allowing me to consider the apparent dichotomy that exists during that confusing and formidable time.
There appear to be three phases through which teens pass on their way to adulthood, exemplified not only in our clients but also in ourselves. The phases can be informally summarized as: you think you have it, then you don’t but then finally you do.
You Think You’re an Adult, but Others Don’t
“I can’t believe they are telling me I can’t when I am practically an adult!” exclaims a 17-year-old wanting to go away with her boyfriend for the weekend. “Everyone” is doing it. “All” the other parents let them their daughters do this sort of thing. How can they be so “unfair”?
In working with this teen, we navigated the tricky waters of helping her to embrace her growing independence while also figuring out ways that she might be able to demonstrate more maturity, sensibility and overall patience. She came to recognize that breaking curfew and not emptying the dishwasher when she had agreed to do so were not helping her case of wanting to appear more responsible. She also naturally needed guidance on tolerance and acceptance, while I supported the parents on standing strong in a very unpopular position.
I, too, remember the times when I was much younger when I was convinced that I was pretty grown up. I felt pretty proud of taking an airplane ride by myself overseas when I was only 5, though I chose to minimize the many adults who were likely closely supervising my journey. I bathed in the glory of my parents trusting me to babysit for my sister when I was a young teen while they were on vacation, despite the fact that I was vomiting in distress by the end of the week. I remember feeling exhilarated the first few months of having my license but much less so when I had to explain to my parents how I had hit a telephone pole a few months later. And most of us have memories of college activities which felt so adult-like in the moment but later were realized to be soberingly immature. There is a difference between feeling like an adult and really being one.
Assisting teenagers and wannabe adults at this stage of transition requires a balance of respectful acknowledgement and gentle challenge. Validating the way in which one is indeed further away from childhood is just as critical as balancing honest feedback about the steps yet remaining. Allowing both parts to be true can provide a smoother transition rather than a stuckness in either extreme. This phase requires full practice of mindful moderation, a concept so applicable to so many other areas of concern to teens as well, including eating, sleeping, and socializing.
Others Think You’re Ready for Adulthood, but You Don’t
“I can’t handle my mother being sick at this point in my life,” reports a 20-year-old whose mother has a terminal, disabling illness. He was being asked to care for his mother because his father often was traveling for work. This young man suddenly found himself having to grocery shop and schedule transportation for his mother’s doctors’ visits, while his father worked more hours to manage the mounting health care costs.
Despite this young adult identifying that he wasn’t ready and couldn’t do it, he actually did step up and handle a number of very grown-up responsibilities. He was overwhelmed at times but ultimately did develop and mature significantly from the experiences. He had times of regret when many of his peers were simply “hanging out,” yet he later came to appreciate the fact that he hadn’t wasted hours in relatively nonproductive activities but had spent time with his mother and time learning skills to last a lifetime.
There have been many moments in my life when I suspect I was considered an adult but didn’t feel like the title was fully applicable. Moving on to graduate school and even getting a professional job felt like I was entering into the adult world, but I could still feel like an imposter at times and hoped others might not notice that I was really just a young person doing grownup things.
Despite the fact that I was making significant decisions in my daily work life and had retirement funds deducted from my paycheck, I often still found comfort in the notion that I was a novice in the whole work arena and retirement seemed a long time away. Getting married and buying a house did require lots of adult responsibilities and decisions, but it still felt like I was just “playing grownup.” Being called “Ma’am” for the first time by the bagger at the grocery store certainly indicated that he thought of me as an adult, but I figured that he was a teenager and didn’t really have proper perspective.
The experience of watching my mother die of a brain tumor during my own young adult years was pivotal in my growth. Holding her hand as she struggled to speak or changing sheets when bowel control was lost required me to step up to take on more adult responsibilities than I thought were possible for me. At the time, I often felt as if I had simply fast-forwarded temporarily into an adult chapter; however, I eventually came to realize that all such learning experiences were part of what launches one solidly and permanently into the privilege of being considered an adult.
This stage seems to emphasize the essential therapeutic step of taking in evidence and evaluating situations realistically. We humans are pretty good at ruminating, distorting, denying, avoiding and fantasizing, and therapists sometimes have the responsibility of helping to provide the perspective, to summarize the data and validate the uncomfortable but important reactions which are part of moving to the next stage in development. Orienting to the positive and to lessons learned allows hopefulness and motivation for moving on, especially in those difficult or tragic situations.
Others Think You Are, and You Finally Think You Are
“You mean I could maybe do it differently than how I grew up?” questions a 25-year-old considering adoption of a different set of political and religious values than those of her parents. She had grown up in a very conservative household and had always been a dutiful daughter, but some of her emerging symptoms of depression and eating disorder were eventually traced back to her finding that she actually had come to disagree with many of the values and traditions practiced by her parents. A significant turning point in her recovery came when she was able to acknowledge to herself and, eventually, to her family that she intended to live her life by a different set of values.
Much to her surprise and delight, her parents were actually quite receptive to this step of independence, reminding her that they loved her even if she chose to have different opinions and dissimilar lifestyles choices. The diminishment of her symptoms wasn’t immediate, but she found that this awareness and this permission to move forward in her own development did dislodge a significant sticking point for her. Her symptoms no longer needed to give voice to what she needed because she had developed the awareness and the confidence to directly voice her needs for herself. A whole new world of exploration opened up for her and allowed her to take on the adulthood stage with renewed enthusiasm.
For me, many moments of parenthood certainly have assisted in my facing the stage of adulthood openly and consciously. Being the primary provider for a young life can be a daunting responsibility, but the accumulation of small but significant moments assist in allowing the adult role to settle in. Each new experience, from settling a colicky baby to taking on a PTA volunteer role to decisively deciding to rush your child to an emergency room provides reinforcement for one’s solid grounding in the adult role.
Learning opportunities continue to present on a regular basis in various areas of life. Most recently, I experienced a minor personal turning point when I had to begin using reading glasses. I have always had pretty decent eyesight and didn’t believe that the report of the inevitable loss of vision in one’s 40s would happen to me, but it has. My sense of invulnerability to the aging process has had to be adjusted, as one really can’t rationalize away or really deny a physical symptom such as this for very long. I have made changes to accommodate the fact that my eyesight is deteriorating slowly but steadily, behaviorally and emotionally. The outcomes are not always as anticipated but generally coping and adjustment can and does occur.
Although change is hard and stressful, it is a critical and expected part of therapy. We support the process of acceptance of self in the now while also encouraging acceptance of change. When clients present with significant life adjustments or traumas to which they must adjust, it can sometimes be helpful to consider the way in which adjustment has occurred at other times and with other circumstances. Having evidence of transformation and acceptance converge allows progression to a more evolved stage. Similar to some of the DBT and ACT core concepts, assisting individuals moving into adulthood requires a balance of these notions. As we model this in session and with ourselves in our private lives, our clients often move on to do the same.
One of my favorite parts of being a therapist is how our own self-awareness and coping in our own lives can help us be more informed and more sensitive about issues going on for our clients. Helping young people to move into adulthood may be enhanced if we take the time to reflect back to our experiences and incorporate necessary reminders for self. Just as it is hard to notice growth in our children on a daily basis, it is hard to notice the accumulation of some life experiences until you look back to examine them. This process is not only interesting and informative, but also brings forth another one of my favorite parts of being a therapist: continual awareness of growth in the therapist.