How to be a highly sought-after adolescent therapist
We know there is a mental health crises (and a soul crises) happening in our youth populations. We also know that finding skilled and available mental health therapists who work with adolescents is so difficult right now that this, in itself, is an emergent crisis. To that end, I share with you here what I’ve learned over the last few decades on how to be an effective adolescent therapist.
Counseling adolescents is very different from counseling children and adults
In 1968, the prominent psychologist Erik Erikson described adolescents as "shiftless Wanderschaft"—shiftless wanderers, implying that adolescents are best served by helping them focus on the future and getting down to the work of becoming adults. In therapeutic work with adolescents and their families, the aim is not only to support these Eriksonian tasks of adolescence but also to highlight and give space to what it means to be an adolescent—a child no longer but not an adult.
Adolescents are not mature children or immature adults. They are adolescents. Their behavior is neither mature nor immature. It is adolescent behavior. Behaviors that people perceive as "problematic"—rebellious and defiant, argumentative, dramatic and melodramatic, risk-taking and impulsive, isolating, bullying, even self-harming—are appropriate to the circumstances to which they are responding or reacting and to their developmental needs and processes. From the perspective of Internal Family Systems, where all Parts have positive intentions, these behaviors are necessary. Every behavior has a reason beneath it; every behavior or symptom is the adolescent's soul speaking.
Adolescence is a stand-alone developmental stage with critical differences in the adolescent's brain, body, spirit, worldview, and psyche from those in children and adults. In powerful adolescent therapy, these differences are brought to the forefront, acknowledged, and honored.
Goals in therapy with adolescents
The first and most important goal in working therapeutically with adolescents is to build trust between the client and the therapist. Often adolescents come to my office with a profound mistrust of adults and authority figures for a variety of reasons—founded or unfounded. Building trust is the foundation upon which the deeper and more challenging work rests. Essential tools for building and maintaining trust with adolescents in therapy are:
impeccable therapeutic boundaries;
deep listening;
a gold standard in confidentiality;
transparency in communications between the client, myself, and their parents
humor;
enormous respect for what it means to be an adolescent in today's world;
the ability to be vulnerable and use self-disclosure appropriately;
and a profound regard for all the ways the young person has attempted to make their life work in the face of extreme challenges.
Once there is enough trust, it’s time to take a closer and more challenging look at what's working and not working in their lives, and what are effective and ineffective behaviors and choices. It is far more helpful to label behaviors as effective or ineffective rather than to use value-laden words such as "right, wrong, good, or bad." Behaviors such as threatening suicide, bullying, or drug use can be understood as a logical choice under certain circumstances. Whether it is an effective choice is something that the client and therapist can discuss, entertaining a wide variety of perspectives to see if they might make the same choice next time or something different.
Gaining skills, tools, support, and resources and learning how and when to implement them is essential to healing. Clear communication with parents, caregivers, teachers, and other significant persons in the child's life, and sometimes coaching and psychoeducation regarding the issues the teen is dealing with set within the context of adolescent development, is part of the child's therapy as well. This is crucial. Helping parents set realistic expectations and eliciting their help in the therapeutic process are vital to the success of the therapy.
The course of therapy
The course of therapy with teenagers varies. Allow for creative scheduling and frequency that meets the teen’s needs. In my practice, meeting weekly for a while, taking a break for a few months, then picking up where we left off is common. Sometimes teenagers will come weekly for a long time. Sometimes they take a break for a year or so; then they realize they're ready to work on some new challenge. I have adolescent clients who, once the rapport is solid, will reach out only when they know they’re in crisis and need extra support.
Learning how to effectively meet life's challenges through the mistakes, failures, and successes experienced in adolescence is the groundwork for meeting life's challenges in the years to come. We must allow the adolescents in our lives to stumble and fall. Our job as supportive adults is to help them get back up, look back with introspection and perspective, and move forward from there. The course of therapy often reflects these movements in adolescent development.
The hallmarks of an effective adolescent therapist
We scaffold them, stepping back to give them space to take risks and try out their newly developed skills.
We trust them to track their own process and reach out to us when they need our support.
We validate them when they enter the therapy room in a messy, dysregulated puddle, with wreckage behind them from ineffective choices or their feelings of certainty that life holds no hope.
And we stay the course with them, knowing they will find their way.
The therapist’s ability to scaffold, trust, validate, and stay the course with our adolescent clients are the hallmarks of a provider who has what it takes to be a significant empowering change agent in the lives of teenagers.
Our work is to constantly check in with our fear for our kids, to continuously clarify the lens through which we see adolescence, and to refrain from colluding with those who have a distorted view of this stage of life and the brave individuals who are doing the hard work of becoming. When we do this, our adolescent clients experience sitting across from someone knowing that whatever they bring into the session isn’t going to be too much. They know there is room for their wandering.
Photo by: tonjung