In the Trenches: Lessons From an Adolescent Therapist

September 9, 2026 — To be an adolescent therapist is to be willing to sit in the trenches; to be in extended uncomfortable silences; to navigate concerned, frustrated, and frustrating parents; to work with parts of us who are frightened for our teen clients and parts who are helpless in the face of our clients’ external circumstances and their pain. If you are a new therapist, even if you love teenagers, meeting them in the therapy room can be like walking into a minefield. 

Early in my work as a therapist, I lost more adolescent clients than those who continued with therapy. I learned quickly what to do and what not to do. I share some of these lessons with you. 

Carter

The first time Carter came to my office was against his will. He didn’t want to be there. His single mother dragged him metaphorically kicking and screaming. He refused to sit, stood with his arms folded, belligerence radiating off of him in thick waves in my very small talk therapy space. Over time, Carter and I developed a strong rapport. He got through the trials that adolescence and life threw at him, made his way into young adulthood with resilience and healthy approaches to the continued challenges. Carter was one of my “success” stories. Though I know enough to know now that it’s not my success but his. 

Here’s what I learned from Carter.

• Let them be belligerent, angry, and resistant.

• Don’t try to placate or befriend too soon. They need to know you can hold the space for whatever it is they bring. Your office or virtual therapy space may be one of the few places and you may be one of the few people who isn’t trying to change them.

• No time is wasted no matter how long it takes to foster rapport and a trusting relationship.

• Set aside goals, strategies, interventions for a few sessions until your client settles in and begins to open up. Or more than a few sessions. It can take time.

Hella

Hella was also a teenager who came to therapy against her will. I worked hard to get Hella invested in the counseling. I worked harder than Hella. I believed with all my heart that I could help her. So did her mom! Eventually, she began to refuse to come to her sessions, and her mother had to cancel them at the last minute. We agreed to end the therapy. At the time this felt like a failure. 

Here’s what I learned from Hella.

• The client has to want to be there. This seems obvious, but it isn’t really. Carter didn’t want to be there when he first showed up in my office. But there was something in him that was ready to do the work. Hella wasn’t ready. Readiness to do the work is paramount.

• In Hella’s case, the issue was bigger than Hella’s symptoms and behaviours. The issue was systemic. Sometimes this a battle we won’t win.

• Hella instinctively knew that she wasn’t really the problem. It was apparent to me and then eventually to her that she was reacting to the problem. Hella was the first one who taught me this, and I see it over and over again in my work with young people. 

Lana

If you see young people in your therapy practice, then most likely you will encounter clients who are exploring their gender identity and sexual preferences. Lana was 13 yrs old and loved coming to therapy. We did great work, and I thought that I had a strong relationship with her parents.

The day came when Lana revealed to me that she wanted to be referred to using they/them pronouns and had let their parents know, who then called for an emergency session. I was a more experienced therapist at this point but not a seasoned one. In this case, understanding my own parts would have been extremely helpful! But I didn’t at the time, and I had a righteous social justice part take the therapist’s chair during that session that advocated fiercely for Lana.

It did not go well, and their parents took them out of therapy. 

Here’s what I learned from Lana. 

• Therapy at its roots really is about social justice, in my opinion. But finesse is needed in some of these fraught situations. Where adolescents are involved, navigating family values, the parents’ rules and expectations, and the adolescent client’s journey of becoming takes an extraordinary amount of diplomacy, patience, and trust in the process.

• I didn’t know it at the time, but the practice and process of validation would have probably saved the relationship between the parents and myself and Lana could very well have continued with their therapy. But I didn’t have those skills, and I alienated their parents. Parents are a key part in most cases where the client is an adolescent.

• Again, if I had knowledge of my parts, I would have also known that there was a part operating throughout my sessions with Lana who had a great deal of hubris. The wonderful relationship that Lana and I had generated a part of me who thought very highly of myself as an adolescent therapist, overestimated the strength of the relationship between me and the parents, and significantly underestimated how quickly things could go sideways. 

The learning curves and consultation

There were many lessons along the way, and there still are! Everyday I learn something new about myself as a therapist, about working with adolescents, parents, and families. I’ve learned that adolescents are complex creatures, and Adolescence is a complex wondrous time.

I learned the importance of boundaries; not rescuing my clients; that clients needed to be working harder than me; that sometimes not being able to help my clients was not my fault; and that I did have a gift for working with adolescents and a great love for them.

I have had parts of me show up in the therapy room that were frightened, overconfident, helpless, determined to rescue, or absolutely certain that I knew what needed to happen next. And, thankfully, I have had colleagues, supervisors, consultants, and friends who helped me become a better therapist.

Over the years, I’ve learned that doing this work well means that I need to lean on other folks, professionals and colleagues who understand and have been in my shoes. I now provide group and individual consultation.

I bring more than 30 years of experience working with adolescents, along with my understanding of adolescence, family systems, and Internal Family Systems. I also bring all of those hard-earned lessons that came from getting it wrong, losing clients, making mistakes, and having wise people alongside me who helped me understand what I could not yet see.

Now, one of my great delights is supporting those who support teenagers. Adolescent therapists need places where they can be honest about the work—the teenager they can’t reach, the parent who has them frustrated, the client they can’t stop worrying about, or the parts of themselves that want to rescue, fix, give up, or simply don’t know what to do next.

Whether in a consultation group or individually, I love offering that kind of space: a place to think together, learn from experience, understand what is happening in the therapy room, and continue becoming the kind of therapist who can sit with these remarkable, complicated, frustrating, and wondrous young people.

Photo by edb3_16