Being an Adolescent Therapist: Challenges, Joys & Tips
Working with teenagers therapeutically is, in my opinion, a calling. It’s difficult work, and the rewards are enormously satisfying. As adolescent therapists, we have to bring all of our experiences, research, wisdom, and resources to bear as we sit with teenagers. And sometimes everything in our toolbox is not enough as some challenges are specific to this age span. Sometimes we just have to hang on for the ride, try and fail miserably, or wander around in the mystery of it all—trusting that it’s all going to shake out somehow. And it usually does.
I’ve spent almost 30 years in the company of teenagers in a wide range of venues, including education, nonprofits, the creative arts, urban, rural, and in the alchemical vessel we call the “therapy room.” Working with hundreds of kids over the years has given me some wisdom worth passing on that might be helpful for practitioners who are beginning their journey or for those who continue to stock their toolbox. Here are four challenges that I have found to be unique to adolescent therapy.
Working with parents
When my two sons were teenagers, our whole family needed therapy. If we had gone to therapy (we never did), most likely their dad and I would have been the parents that many therapists are challenged by. We knew nothing about adolescent development, conscious parenting, how fear can undermine relationships more than any one emotion, or how unresolved issues from our own child and teen years affected our parenting. Overwhelmed, afraid for, and frustrated by our kids, we would have been the parents who walked into the therapist’s office and said, “Fix my kid,” resistant to the idea that their behaviors and struggles had anything to do with us or our parenting.
Adolescent therapists know that within those three words—or the implied directive to fix the kid—lies a lifetime or several lifetimes of family systems gone awry, in addition to all of the current issues facing our young people. The social and neuro-development of this age also makes therapy difficult. Teenagers are striving and demanding more autonomy with less impulse control and less parental oversight.
The adolescent therapist must know how to skillfully navigate these often troubled waters. The therapist develops the rapport with the teenager so the child is assured of the therapist’s support and alignment. At the same time, the therapist must communicate with and develop a working relationship with the parents so the parents trust that the therapist has the child’s best interests in mind. Ideally, the therapist and parents become a team in full support of the child’s health and welfare.
Tips for the therapist:
Be clear with the parents that you are their child’s therapist. Not theirs and not the family’s therapist.
Work with your own parts that get activated by parents so you can be present to them with understanding and compassion.
Remember, parents need validation too. The aim is for parents, with your support, to be confident in their ability to usher their teenagers through adolescence.
Be prepared to do a lot of psycho-education and parent coaching, if the parents are open to it.
Confidentiality
I’ve written elsewhere about confidentiality in adolescent therapy. It can be challenging to hold confidentiality as the child is still under the care of parents while also of an age where they have the same privileges in confidentiality as adults. It is the gold standard of confidentiality that will exemplify your work as an adolescent therapist.
Adolescents in our culture lead extensive secret lives, as a cursory search shows. For those teens who are fortunate, paradoxically, to find themselves in therapy, they have the opportunity to reveal their secrets to a trusted adult, especially if the relationship between the child and the parents is off-track. The adolescent therapist can help the child process their decisions in ways that parents may not be able to. The therapeutic container must be solid and must hold. Confidentiality is one of the key factors in the strength of that container.
Tips for the therapist:
Develop a clear confidentiality policy and abide by it without fail.
Aim for full transparency regarding communication with, between, and among you, your teen client, and their parents.
Seek supervision whenever you are in doubt. Which may be often with teenagers and the issues they bring into therapy.
The reluctant/resistant teen client
What do you do about the teenager in your office who doesn’t talk? Who doesn’t “do therapy?” Who shrugs and says, “I don’t know” at every attempt you make to connect? You are a stranger. They have no reason to trust or respect you or talk to you. They may test you for quite a while.
I have had teenagers come into my office who refused to sit, refused to talk, who shrugged and mumbled through their entire session. I’ve had young 12-year-olds just beginning their journey into adolescence who refuse to leave the waiting room. I’ve heard from other teenagers who tell me that they’ve been “fired” by their previous therapists after being told that the young client wasn’t taking advantage of the therapy, that they weren’t really “doing therapy.”
What do you do in the face of the teen client who resists?
Tips for the therapist:
Know that every moment is fodder for therapy. As soon as they enter the door or get on screen, the therapy has begun. Much of the efficacy of therapy has to do not with how they show up but with how you show up in that hour.
Take all the time you and the child need to build rapport and trust. Depending on the level of trauma, this may take a few sessions or even months.
Have something to do rather than sitting and talking. Games, art, sand tray, taking a walk, fidget toys, etc are all helpful.
Recognize and work with the parts of you that have an agenda for the client, that have aligned with the parents and need to “fix” the child, or parts that are also frozen in the face of the client’s frozen resistance.
Get comfortable with silence.
When nothing works
Of all the things that I can offer adolescent therapists from my experience is this—the understanding that sometimes nothing works and nor should it. Sometimes teenagers just need to be “in it.” They need to swim in their stuff—the dramas, the heartache, frustration, loneliness, the doldrums, the sadness, the highs, and the lows. We do a disservice when we try to mitigate or diminish the suffering that comes with any transformative process. Which is what adolescence is.
The world our teenagers are navigating these days is a far different one than at any time in our recent history. While there have been pandemics, global conflicts, and political unrest in the past, never have young people had to navigate these with access to social media and the ever-present, palpable, looming unease of climate change.
In some cases, the most skilled adolescent therapist is not the one who alleviates pain in the young client but the one who sits in the darkness with them. The wise therapist confronts their own unease, distress, and hopelessness to be able to companion their young client. There are no easy answers here, and the questions are essential ones.
Tips for the therapist:
Move slowly when diagnosing. Be a psychic detective. For example, is this clinical depression or is this grief?
Take care of yourself. Explore your own grief and existential questions and fears. Work on coming into relationship with your own Inner Adolescent.
The Takeaway
Know that your work is essential.
Photo by: Alliance