Why Teens Hate Therapy
Mistakes therapists should avoid
By Janet Sasson Edgette
"How do I get her to talk about her feelings?" asks Jean, a counseling intern about to meet 13-year-old Hannah for an initial appointment. "I'm not sure what to say to her." Hannah will be the first client Jean has seen without a more experienced cotherapist at her side, and she's worried.
Oh boy, I wonder privately. Are they still teaching that good therapy means getting kids to pour out their feelings? I'm suddenly reminded of a teen client I'd seen years ago who, when I asked what hadn't worked in her prior therapy, began a mocking singsong of her therapist: "So, Cindy, how does that make you feel? How does that make you feel? How does that make you feel?" "Ugh," she continued, "enough already with my fucking feelings. It made me feel like I just wanted her to shut up! That's how it made me feel!"
"Don't worry about getting her to talk about her feelings," I say to Jean. "If you're doing anything close to what Hannah needs you to do, you won't have to. She'll show you what her feelings are."
It hadn't been all that long ago that I, too, had thought a client's feelings were the Holy Grail of therapy. But I've realized in the years since that direct questions about feelings are actually a source of irritation to kids. They'll talk about them, alright, but not in a discussion isolated from the conversation at hand, with a spotlight turned on it. Besides, the question itself is now so predictable, parodied even by the people it's supposed to serve.
Most teens are in therapy only because their parents, their teachers, the juvenile court judge, and/or some adult in authority somewhere has told them they must see a therapist. Consequently, they often find most standard, shrink-wrapped attempts to "engage" them infuriating. For example, to the therapeutic bromide, "We're not here to talk about me. We're here to talk about you," their (usually unspoken) response can only be, "You may be here to talk about me, but I'm notâ[euro]"I never wanted to talk to you in the first place." In short, they don't talk, don't want to answer questions, don't want to be in our offices, and don't intend to make it any easier for us, so we often resort to our stale therapeutic clichÃ©s because we don't know what else to do. It's probably fair to say that most teens, being highly protective of their emerging selfhood, loathe therapy sight unseen, and that too many hate it even more once they've had a taste. At a time when adolescents and preteens need our help in navigating the multiple challenges of family, academic, and social life more than ever, the gap between clinical theory as taught in graduate school and real-life practice continues to widen, unfortunately.
Most of us were never trained to talk to adolescents. I was taught psychotherapy by psychoanalysts, who worked hard to instill in me an understanding of the importance of unconscious conflict, character structure, object relations, interpersonal dynamics, and transference. It was great training and has proved highly valuable, but it was a beginning, not an ending. This hit me right between the eyes when I took my first job as staff psychologist at a residential treatment center for socially and emotionally disturbed boys and girls who didn't give a crap about their unconscious conflicts or anything else having to do with therapy. I'd ask them, "What are your treatment goals?" and they'd look at me as if to say, "Lady, is there anything on my face that says I have a treatment goal?" I'd make an interpretation of their behaviorâ[euro]""I wonder if you yell at your mother when she asks you where you're going because it feels invasive" or whateverâ[euro]"hoping to spark a little insight, and they'd stare blankly at me for a moment before getting up and leaving the session.
When I began treating adolescents in earnest, I realized that if I wanted to keep one of them sitting in my office for more than half a session, I'd have to change how I spoke with them. …