THERAPY FOR TEENS / ADOLESCENTS
Overview
The teenage years are where most of us begin to solidify our personalities. We have many influences during adolescence, including teachers, friendships, families, and culture. It is a time for trying-on different things, including everything from clothes and musical tastes, to one's beliefs, opinions, values, and even friendships. The goal is to work through this process in order to see what feels most comfortable in defining who we want to be as individuals; we keep what we like, and eventually discard the rest. As teens are maturing physically, cognitively, and emotionally, they also begin to take more responsibility for their lives and gradually move toward greater independence, which naturally involves a re-defining of family relationships. While adolescents are attempting to meet these developmental goals, the goal of their parents is to support their teen through a successful transition from childhood to adulthood.
Though the teenage years can be an exciting time, it can also bring a significant number of challenges for both teens and their families. Life can become stressful, frustrating, confusing, and filled with mixed thoughts and emotions. Intense pressures to find acceptance within peer groups and to conform to peer and cultural expectations can be overwhelming and may leave a teen feeling very anxious, isolated, alone, and even depressed. Adolescents may also feel less comfortable using parents as an emotional support, due to their increased need for autonomy and privacy, or due to the sensitivity of certain concerns that might make it hard to feel like parents would be an objective or impartial sounding board.
Teens also face challenges unique to their physical and cognitive level of developmental. Early puberty, for example, can create a situation where a teen's body might be ready for adulthood long before they are. And while adolescents are developing cognitive skills such as abstract reasoning, rational thinking, and more advanced forms of problem-solving, they may still be prone to black-and-white or all-or-none forms of thinking. This point, combined with the emergence of strong pubertal emotions that can often overpower reason, puts teens at greater risk of making impulsive decisions and actions. It is often helpful to have an impartial sounding-board to discuss, explore, and validate emotions. However, it is often the case that many adolescents find it hard to articulate their feelings or even know sometimes what they feel. Just talking about their worries can be embarrassing due to external pressures suggesting how they are supposed to feel or act. For these reasons, it is important for teens to have a voice in therapy, to tell their story without feeling judged, criticized, or pressured and to get help in expressing their thoughts and feelings when they become hard to articulate.
I work with adolescents around a multitude of issues, including:
- Low self-concept or negative thoughts and feelings about oneself or one's future
- Social anxiety or excessive stress/worry about peer acceptance and social relationships
- Physical or psychological bullying at school or by peers
- School anxiety or excessive stress/worry about academic performance or fear of failure
- Obsessive thoughts (e.g. irrational or excessive fears) & compulsive behaviors (e.g. hand-washing)
- Dealing with grief, loss, and/or parental separation and divorce
- Difficulties negotiating adolescent-parent boundaries, rules, or expectations
- Difficulties maintaining appropriate communication with family members
- Coping with additional family issues, including parental health concerns
- Adjustment concerns related to moving to a new area or starting at a new school
- Gender identity and concerns related to one's sexuality
- Concerns related to peer groups or intimate relationships
Eating disorders and drug addictions: Please note that while I do treat underlying emotional issues related to eating disorders, I only do so when the disorder is under relative control or in collaboration with a team of professionals actively treating the primary disorder. Due to their physical health component and their seriousness, I believe that the active management of anorexia and bulimia is best left to physicians and a clinical team specializing in their primary treatment. Also note that while I similarly treat emotional issues related to drug use and abuse, I do not specialize in the primary treatment of severe drug addictions and would defer to individual therapists and/or specialized addictions programs that are capable of bringing the behavioral addiction under control. If any of the above applies to your situation, please feel free to contact me and I will be happy to point you toward some helpful resources.
Confidentiality with Teens
Confidentiality is extremely important in order to be open and expressive in therapy. Teens need to know that what they share with a therapist will be respected and will not be openly and unconditionally discussed with parents without their permission. I always discuss my policies around confidentiality during the first session; usually with both the parent and teen.
In Nova Scotia, any person under the age of 19 is considered a minor. The competence of minors to provide informed consent to therapy services is not assumed and parental or guardian approval is often needed. However, as children grow more able to understand and choose, they assume legal rights. An individual may be considered a 'mature minor' if it is judged that they can understand and appreciate the nature and consequences of their decision to pursue therapy and its alternatives. In these cases, the details of things they discuss may be treated as confidential, though parents or guardians do have the right to general information, including how therapy is going and major safety concerns that might arise. Although there is no set age limit for an individual to be considered competent to give consent, the mature minor status is typically considered during adolescence and on a case by case basis.
How to Help Someone Who Never Asked For It
Adult therapy clients usually engage in therapy of their own free will and most adults have a pretty clear idea of the issues or concerns they would like to address in therapy. In addition, most adult therapy clients generally trust the professional role of the therapist, and in my experience, are able to open up about their thoughts and feelings with little difficulty. It would seem to me that the above points are more exceptions than rules with adolescent therapy clients. It is often the case, for example, that teenage clients do not know what issues need to be addressed. There is not always the same sense of trust and safety with the therapist more often than not, it needs to be earned. My approach may therefore involve taking more time to build the therapeutic rapport, which is necessary for anything therapeutic to happen. Sometimes teens may express that they do not want to talk to anyone or to be in therapy. If this is the case, I think it is something to be worked-out in the therapy session; sometimes involving those people who think they do need to be there (i.e. parents).
Another challenging issue is when teens insist that they will not go to therapy. If this is the case, I encourage parents to reflect on why they believe their teen should go. Sometimes parents will have obvious concerns about their teen. These concerns may relate to taking care of their physical or emotional health, communicating effectively and respectfully with the family, or meeting age appropriate family responsibilities. It is the job of any parent to ensure that their teen is taking care of themselves in healthy ways. I believe that if parents have evidence that they are not, it is the parents right to urge their teen to get help. To motivate their child to do so, they may need use what influences they have, including the withholding of privileges until their teen can show them that they are taking steps to resolve real parental concerns - these steps may involve attending therapy. Privileges might include: T.V. time, internet use, cell phone use, weekly allowance, transportation, or anything provided by parents that are not a necessity of living or a right for them to have. Even if teens end up in therapy to avoid losing a privilege, in my experience, they quickly learn that the individual therapy time is truly theirs and that it may actually be helpful.
