Therapy with Adolescents

Therapy with adolescents is quite complex. The teenager is establishing their psychological independence and relying on friends to understand what they believe their parents and teachers cannot. There is a certain truth to the belief that one’s parents do not, and probably cannot, understand the culture that a teenager lives in. Technology, breadth of exposure to society due to the greater interconnectedness that the web and the media provide, improved nutrition, the world of video games and skateboarding, the increased pressure of school, athletic competition, and an increasingly sophisticated world of fashion, all contribute to a gap that we adults have difficulty crossing. For the adult, advances in these areas are changes we learn about and accommodate to in varying degrees; for our teens, it has always been their natural, expected context and language. 

At the same time, of course, there are certain universal truths that transcend contemporary shifts in knowledge and capacities. The nature of family, relationships, self-awareness all have some enduring meaning in the human experience, even though they, too, change their outward appearance as the times change. 

However, it is hard to separate the difference between what truly is different these days and what may seem different but is really the same. Today’s young person has this task, along with resolving the various issues and concerns about taking responsibility for one’s life and making something of it. While we adults may feel that’s no different than what we had to go through- our parents didn’t get what we were about and into, either- the fact is that today’s kids face change at greater intensity and at a much higher pace than any previous generation. 

So what does this mean for adolescent therapy? Several things come to mind. First, the therapist needs to be open to the teenager’s experience, while, at the same time, not trying hard to look like one himself. Kids appreciate authenticity, partly because they are hoping to find it in themselves. Next, absolute confidentiality is key to working with teens because of the very real struggle to find, and be, themselves as distinguished from being simply their parents’ child  This means that what is said in the therapy office is entirely, inviolably private. Parents, even though they are footing the bill (and have been for the youngster’s lifetime) simply do not get to hear what is said in the session- unless the youngster wants them to. There are exceptions, of course. If a teen is in actual danger of hurting themselves or being hurt by, or hurting, someone else, confidentiality must be broken and parents, other health providers (crisis response, emergency services), or, if necessary, the police, are notified. This is entirely based on concerns for physical safety; developing emotional states that could lead to these situations are still kept confidential, and revealed to others only at the point where, in my judgment, actual danger for harm exists. The issue of confidentiality is crucial to the success of therapy, and requires a high level of trust on the parts of both adolescent and parents. 

Next, my job, as it always is in therapy but, in the case of adolescents, is even more crucial, is to listen beyond the immediate circumstances and to try to understand how the teen’s communication to me fits into not only their current context, but their potential future. This can amount to a different reaction to various behaviors than parents or school personnel might have. For example, a child who is flaunting the rules at school may have to deal with the consequences from school and home, but, in therapy, needs to be understood in terms of how that behavior, once it is used more effectively, represents a positive capacity that may be a particular and unique strength of the youngster’s. So, while the goal of therapy is better adaptation (in the sense of balancing one’s own uniqueness with the requirements of life in the world), therapy cannot be seen as a mechanism to “make” a young person behave better, think differently, or adhere to a family, parental, school, or societal expectation. Therapy can, and should, help a young person feel better about themselves, use their skills and capacities effectively, and, where necessary and possible, enhance communication at home, and these outcomes may bring the young person closer to parental hopes and expectations. 

What can family expect, then, if the therapy is directed toward the inner well-being of the teenager? Hopefully, two things happen. First, the young person works on the discomforts, etc. that they face. As this is occurring, it is to be hoped that the parents and siblings can bring their concerns about the youngster to the table, and mutual understanding, and mutual accommodation, can take place. It is rarely the case that a youngster’s difficulties are entirely within them, and, as soon as they get better, the family is happier. There is almost always a mutual exchange, an agreement to alter past patterns of interaction between other family members and the youngster in treatment, that enables the family to become a better facilitator of the adolescent’s growth and a more effective unit for each of its members- including the parents. 

In terms of diagnosis, please see my note. It may at times be helpful as a guide to treatment decisions, but it is a particularly unwieldy double-edged sword with teens. The ideas, feelings, behavioral explorations, etc. that a teenager experiences and exhibits are all quite fluid, and may well be both necessary and temporary states. The danger, therefore, is that of labeling someone with a diagnosis that may stick in people’s minds while they are in the midst of a necessary exploration of life, and follow them and influence reactions to them after that exploration is completed. 

Other vital topics include depression, suicide, drug and alcohol use and abuse. These are best discussed within the context of the adolescent’s life circumstances, and should be raised in person in initial meetings.