The Four Most Common Mistakes in Treating Teens

Article excerpt

Most therapists agree that teenagers can be among the most difficult clients we see in our practice. They often refuse to attend sessions, refuse to speak when they do attend, swear at parents and therapist, and storm out of the room when they hear things they don't like. Difficult teenagers often argue head-to-head with adults and professionals using arguments such as, "I'm not going to give them any respect if they don't give me respect," and "It's my life." At times such teenagers have thrown objects across the office. One particularly aggressive 12-year-old girl once threw her wooden-soled sandal directly at my face hollering, "I'm glad I'm not one of your kids!" Some teens are so direct that they come out and say, "There's nothing you (the therapist) or them (their parents) can do about me."

Any therapist treating domestic violence takes one look at a husband who is dominating and abusing his wife and recognizes that he exercises power over her. Yet, when a teenager threatens, dominates by shouting and imposing guilt and controls her parents by threatening to run away, too many therapists fail to realize that abuse is going on.

Adolescent and preadolescent behavior begins at younger ages as our culture educates them more rapidly. As psychologist David Elkind pointed out decades ago, children are growing up more quickly and losing their childhoods too early in our fast-moving society. As teenagers become adult-like at earlier ages, they see themselves as "equal" to the adults. Our society isn't teaching them that while they are valuable individuals, they don't have the same authority as adults. Teens are extremely vulnerable to believing that they can handle everything and don't need adults. They are struggling to take control of their lives at the same time parents area struggling to give them that control only when they're ready to handle it. There's a natural power struggle.

So, how does a therapist treat a struggle between a teenager and his or her parents? Does he ignore the power issues and treat everyone as equals or, understanding the need for order in a child's life, does he provide support and leadership? Therapies that advocate support without leadership fail, giving teenagers too much control. They begin to lag in school and get in trouble with the law. Emphasizing the clinical significance of leadership isn't new--Jay Haley, Cloe´ Madanes and Salvador Minuchin encouraged therapists 30 years ago to recognize the need for order and direction in a family's existence. The more stuck a case is, the more critical it is to take charge of the treatment.

There are four common errors that therapists make with teenagers. They are surprisingly simple to grasp, and they always make matters worse:

mistake1   Courting the Teenage Client: The seeds for the countertherapeutic courtship of teenage clients are generally laid in the initial phone call from a parent. The first words out of a parent's mouth often are something like, "The counselor at the school said we need to bring John in for family therapy, but John says we're the crazy ones and he won't come in. He said he wouldn't talk even if he did come in." This is the number one power tactic teenagers use to keep therapy from happening. When therapists tell parents there's nothing to be done if their child won't cooperate, we might as well say, "Sorry folks, but you better get used to your son's running your family."

At our clinic, our typical response when confronting this situation is to tell parents on the phone that we treat kids who "won't cooperate" all the time, and that they, the parents, must decide whether therapy is to happen. We suggest they tell their child that the session is scheduled and she's expected to be there, and if she is not, the grown-ups will meet anyway. We also coach the parents to point out that the adults will be talking about their child behind her back and making decisions about her life. Most kids come to the first session after hearing this. …