Getting to Better™ Events Leadership Blog

August 2011 | Teens & Therapy: Important Considerations

We at Getting to Better promote respectful, caring responsive and supportive relationships through family and community as foundational to the development and overall well being of children and youth. During the adolescent phase, the road to adulthood can be fraught with many challenges; for both the youth and those around them. While most teen challenges can be met and managed through caring and supportive relationships, some situations may require formal help and/or therapy. This particular newsletter has been written to address some common concerns raised by parents and caregivers about teens and therapy.

For over 15 years, we have had the pleasure and the challenge of working with many teenagers in therapy. This work has come with a variety of ups and downs and many surprising twists and turns along the way. Therapy can be a wonderful and useful outlet for a teen that is experiencing challenging issues in their lives. However, they have to be ready to make that journey. Therapy takes work, it takes honesty; it takes looking at parts of ourselves that we are not always proud of or happy about. It can be daunting, and at times overwhelming, but therapy can be positive, affirming and life changing and, if one is ready, can facilitate a tremendous amount of growth in self and within relationships.

Many parents and/or caregivers think that some teens “need” to or “should” be in therapy. They may even drag the teen to the therapist’s office (sometimes literally kicking and screaming) and expect change to magically occur. It would be amazing if there was a “magic” person who could instantly “fix” all the trials and tribulations of adolescence. Unfortunately that person does not exist. What does exist are therapists who are ready for the opportunity to listen, empathize, support and hopefully help teens with challenges and important life changes.

Some adolescents go to therapy willingly, with an open mind, ready to make changes, ask questions, take suggestions, look inside and “get to better”. This is not always the case. Most teens can be reluctant to do some things their parents want them to do; therapy can be a big “no way!”. The remainder of this article will discuss some of the struggles, challenges and benefits of beginning and continuing therapy with teens and will aim to answer some common questions:

  • What are some issues that may require therapy?
  • How do I know that therapy is right for my teen?
  • How is therapy with teens different than therapy with adults?
  • How do I tell my teen I want them to go to therapy?
  • What do I do if they are reluctant to go?
  • What do I do if they refuse to go?
  • What are points to help in getting started?
  • Confidentiality with teens in therapy: How much information will I get?
  • What might my role be as parent/caregiver in the therapeutic process?

What are some issues that may require therapy?

As stated earlier, the adolescent road to adulthood under ideal circumstances can be challenging for both teens and caregivers alike. It is not uncommon for the teen journey to be filled with experiences that range from minor but aggravating to one or more trying tribulations. When life difficulties start to negatively impact functioning and daily routines; jeopardize relationships; compromise overall physical, emotional, mental or social well being and/or; are beyond the capacity of the teen, the family or the caregivers’ capacity to cope, it may be a necessary option to consider formal help and/or therapy.

Some Common Therapeutic Issues for Teens

  • Learning problems/trouble in school
  • Abuse issues
  • Disordered eating
  • Depression
  • Anxiety
  • Family conflict
  • Peer conflict
  • Oppositional and or aggressive behaviours
  • Suicidal/self-harming behaviours
  • Self-esteem
  • Divorce/Separation
  • Grief
  • Substance use

How do I know that therapy is right for my teen?

Most parents would like to see their teen healthy and happy in all areas of life. This is a tough thing when teens have to deal with peer pressure, hormonal changes, academic expectations, social issues and self-discovery all at the same time. Adolescence is a time of great change, increased responsibility, emerging relationships and romances, but still the feeling of being a “child” in many ways. Therapy for adolescents may be indicated if your child is struggling in one or several areas of life and you are feeling like they may need a place to talk about or work on their issues. Therapy can offer a safe, non-judgemental space for your teen to open up about what is going on in their lives with an adult who has no expectations or specific goals for their future. Many teens relish the opportunity to talk about themselves to someone who really listens or “gets them”. A therapist working with teens has the wonderful opportunity to be that person.

How is therapy with teens different from therapy with adults?

“Adults have learned through time to verbalize complex and contradictory feelings and reactions. However, adolescents generally find it more difficult to eloquently verbalize such feelings: they are often overwhelmed and even confused by the onslaught of complex feelings that come as they move towards adulthood.”

Adults often choose to engage in therapy, know what issues they want to address and, are able to articulate their goals. Adults usually are able to trust in the therapist role and are willing to open up and engage in the process. This may not be the case with teens. Trust and safety is something that develops over time and needs to be more explicitly addressed in therapy with adolescents. Building rapport is generally the first step a therapist will take in working with a teen. This first step may happen quickly, depending on the teen, the issue, the moment in time. But this step may be one of the most challenging for a therapist working with teenagers. Rapport and relationship building may take time and parents should be aware of this important and necessary step.

Depending on the individual adolescent, “talk therapy” may not always be the most effective approach. The idea of sitting in a room straight across from the therapist and having to talk for an hour is often a hard concept for adults, and can be even more difficult for teens. What do I say? What questions will the therapist ask? What if I don’t have the answers? What if I am embarrassed/afraid/worried about my problems and how they will sound out loud?

Other forms of therapy that allow for an activity or experience are often helpful alternatives to traditional talk therapy. Art therapies, play therapy, car therapy, walking therapy are some examples that may work for some adolescents. We have often been told by teens that talking about emotional and embarrassing issues is so much easier when sitting/walking side by side than face-to-face. This experiential and active therapy can take away some of the perceived pressure of “talking” and can allow the relationship between the therapist and teen to develop in a way that is reflective of their current life experience. Teens most often do not sit and talk with friends, but they play sports, watch TV, play videogames, do homework, and/or listen to music together. A great deal of therapeutic work can occur when just “hanging out”. Creative experiences (writing, drawing, sculpting etc.) can provide some distance from the real emotions and feelings and can allow teens to express themselves in ways other than using words. However, if you ever feel that your teen’s therapist is only “hanging out with my teen, playing and drawing” and not accomplishing much, check it out with the therapist as to the goals of the therapy process.

How do I tell my teen I want them to go to therapy?

Teens usually have a general understanding about therapy. You might want to let them know your concerns, what might be covered in therapy and how you feel therapy may be helpful. Therapy should never be a punishment for bad behaviour. If it is started on these terms “See what you did? Now you will have to go see a therapist!” then therapy may not be productive or helpful. Therapy is not a punishment, but a tool that can be used to help things get better. Framing therapy in a positive light is a good starting point.

Helpful Starting Points

  • Talk to your teen about the behaviours that worry or concern you. Let them know in a rational and non-threatening way what you are worried about and why. Show your child you care and want the best for them. Keep emotions in check (especially anger) and base your concerns on what you see and hear rather than how your child’s behaviour affects you. Let your child know how therapy may be helpful for him/her, not you.
  • Tell your teen that you believe in their ability to make positive changes in their lives. We all strive to be our best and we all want what is good for us, we just may not always know the most effective way to get there.
  • Introduce the idea of therapy. Give some time for this to sink in. Don’t expect an immediate response and it may be helpful to give them some time to think it over.
  • Listen to any fears or concerns that they may have. Validate their feelings. Address concerns if you can, or let them know you will address them as soon as possible. Let your child ask questions.
  • Allow your teen to be involved in the process of finding a therapist. Ask them who they may prefer to see (male/female, older/younger etc.).
  • Let your child know that they can try it out and go for a few sessions. Often times, if teens feel they do not need to make a huge commitment to therapy they will be more willing to try it out a few times to see how it feels.

What do I do if they are reluctant to go?

Often parents are more concerned about their teen’s behaviour than their teen may be. This can lead to arguments and conflict if you think your teen could benefit from therapy but your teen does not think they have a problem. Your child may have many reasons for not wanting to attend therapy. They may be embarrassed, worried about what others will think, think that therapy is just for “crazy people”, or they may be lacking insight into their own behaviours and how they affect the people around them.

The first thing you can do to help with the process of getting them to therapy is have a conversation, engage in a discussion, listen to and validate their concerns, address concerns that they may have, and share your own experiences with therapy or counselling if you can. Many teens are willing to give it a try if they are first listened to and feel heard about their fears and concerns. If they agree to go to the first visit, consider it a success. If they go back for a second time, then there is a better chance therapy will be successful. Actions speak louder than words, and teens often feel the need to protect their pride, so even if they are saying “this is a waste of time” but continuing to go, this means they are somewhat engaged in the process.

What do I do if they refuse to go?

You can force your child to go to therapy. You cannot force your child to participate. Teens can be wonderfully stubborn when asked to do something they cannot do, are not ready to do, or are afraid of doing. Therapy needs to be something that a person is willing to try, even if they are very unsure of what may happen or how it may be helpful.

If your child is refusing to go you may want to leave it for the moment. Approach the topic again later and see if things have changed. With time and patience a teen may feel that their feelings are validated and may be willing to try therapy out. If safety is a concern or potentially harmful behaviours are occurring, then the need for help may outweigh your teens choice in the matter of therapy.

You could make your child go to therapy. Sometimes this can work (depending on the child, the problem etc.). Sometimes if a child goes, sees what therapy is about, connects with the therapist, and feels okay, therapy could work. This is a risk as your teen may be angry with you, but depending on your child and your relationship with your child this may be a risk you are willing to take.

You, as the parent/caregiver could set the example and start going to therapy yourself. There is a great deal of work that a parent can do, on their own, to help themselves and their children. This may involve getting support, having someone listen to your concerns, getting helpful tips, or addressing family issues. If a teen sees that you are willing to work as well, and it is not just ALL about them, they may then join you or attend on their own.

Confidentiality with teens in therapy: How much information will I get?

The amount of feedback and the kind of feedback you will receive from your teen’s therapist will vary depending on the age of the child. If too much information is shared with the parents this will damage the relationship and the teen may be unlikely to ever trust the therapist fully. If a teen feels that the therapist and their parents are on a “team”, and competing against them, then the therapy process can be in trouble. In adolescent therapy it is often helpful if the teen feels that they are part of the team and that the parents are on the team also; or at least on the sidelines.

There are limits to confidentiality in all therapy settings. The following must be reported: if a child (or another vulnerable person) is in need of protection; if there are threats to harm self or others; or if therapy records are subpoenaed by court.

Parents often ask if they will be told about issues such as substance use or sexual activity. These behaviours are not included in the limits of confidentiality and therefore a therapist is not legally required to report. The therapist should always have an open and honest conversation with teens and their parents when beginning therapy. It is important to explain confidentiality and its limits, what must be reported and what does not have to be reported. It is important for the therapist to always let a teen know that if there is concern for their health and safety and, if they seem to be engaging in behaviours that are harmful the therapist will support the teen in telling their parent. A teen always has a choice of what they want to share. It is a good idea for parents/caregivers to be clear with their teen’s therapist about what information will be shared.

What might my role be as parent/caregiver in the therapeutic process?

Family therapy is essential when working with an adolescent. Communication skills and the inability to resolve conflict are two common reasons parents bring their kids to therapy. Communication and conflict resolution both involve more than one person. A therapist can work with a teen to develop skills and explore conflict, but if the parent is not able/willing to make changes themselves then there will likely be little to no change in the relationship.

Some parents and caregivers bring their teen to therapy saying (or thinking) “fix my kid!” Usually when working with children and teens the therapist will ask the parents to be involved in some way depending on the issues that brought them to therapy. This may include family sessions, parent sessions, homework, and supporting your teen in the changes/choices they decide to make. Parent sessions are a great place to ask questions and evaluate progress with your teen’s therapist.

In families we can approach the concept of change from a ‘top down’ perspective. The analogy of a workplace is helpful to paint this picture. Imagine a group of employees who are unhappy at work due to a boss who does not listen, criticizes, yells, makes unreasonable demands, gives more duties than can be done and has a closed door policy. Someone can help the employees by listening to them, helping them make changes to be more assertive with their boss, or by finding a new job, but if the boss does not change then the cycle of dissatisfaction and unhappiness will continue. If the boss is willing to take a look at their behaviour, listen to their employees and make some changes, then positive change in the employees will occur much quicker!

When parents work with their teen in therapy and allow the process of improving communication, knowledge and respect of each others’ experience, they can dramatically enhance their relationship and create the environment for positive change.

*For further details and information on choosing a therapist and supporting your child in therapy, check out the 2010 October and November Newsletters.

References

http://prattcenter.com/child-and-adolescent-therapy/psychotherapy-faq
http://www.examiner.com/teen-issues-in-san-francisco/counseling-101-how-do-i-get-my-teen-to-go-to-therapy
http://www.thekidcounselor.com/articles/teenagers-and-therapy-how-to-make-it-work

A BIG Thank You to Getting to Better Team Member, Lindsay Woods-Frohlich M.A., Ph.D. Candidate, for her contribution to this months Newsletter!

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