Tip 1: If an adolescent client shows up for an appointment, frame it in your mind and theirs that they are very motivated for treatment.
More often than not, youth are brought to treatment by a parent or caregiver focused on dropping off the problem child for you to fix. Very few adolescent clients wake up one day and spontaneously declare, “This is the day to seek treatment.”
So when an adolescent shows up for that first appointment, how can you frame it as working with a very motivated client? Think of it in reverse. If they did not want to go to the appointment, how easy would it be to force them to go? Have you ever tried to nag, yell, cry or physically move them to do anything? How is that working for you?
If a youth gets into the car, the waiting room and then the office, they are very motivated for something. That “something” may be to:
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Get the parent off their back and to leave them alone
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Get their phone back or some other privilege that was withheld
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Get off a one month grounding
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Or for some, happily, to actually want therapy work to feel better.
Whether it is to avoid some negative consequence or to actually find relief from internal pain, they are very motivated. The outcome and goal of treatment may then be:
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Let’s see how we can work together to get them off your back.
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Would you be willing to explore with me how to get your phone back?
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I’m willing to work on helping you get off grounding if that’s what you want.
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I’m sure we can work together to help you feel better.
Tip 2: Don’t put adult expectations and values onto adolescents when it comes to communication and engagement in treatment.
Have you ever had conversations with a youth that sound like this?
How was school today?
Fine.
How can I help you today?
I don’t know.
What’s going on right now?
Nothing.
Even adults can have trouble knowing what they are feeling and how to articulate that. For youth, it can be all the more challenging to identify their inner feelings and express what is going on in the moment.
One of my adolescent psychiatry supervisors taught me the following method to help adolescent clients identify inner feelings:
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Rather than talk directly about the client in the room, he suggested you share observations about other similar aged youth he had worked with – “There are some clients I’ve worked with who felt it was their fault when their parents divorced and they got quite depressed and self-blaming.”
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“Some young people your age find themselves unsure about how to handle anger or hurt feelings or feel like they don’t belong.”
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Test out educated guesses about what might be going on with your client and observe for any resonance, identification or opening up from your adolescent client.
Tip 3: ”Thank you for coming today. What’s the most important thing you want that made you come today?”
Motivation to avoid a negative consequence (stop the nagging or get my phone back) is just as clear and legitimate a treatment goal as “I want to feel better from my depression.” What is most important to the client should be the goal of treatment, not what you think they should be working on. This allows for accountability and outcomes monitoring.
Whatever the goal of treatment, involve the adolescent as well as the parent(s) or caregiver(s) at every session to get real-time data on whether everyone is getting what they want. For example:
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Adolescent’s goal: Get my parents off my back. Parents’ goal: Get him to behave.
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At each session, see the adolescent first to see how often his parents were nagging him this week and what he was doing that provoked the nagging; or what worked if the nagging was less.
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Usher the client out to the waiting room and bring in the parents. How was the behavior this week and what did you do if it didn’t go well; or what worked if it did go well?
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Bring them together to compare notes on what happened this week from each other’s perspective. The therapy work is for the adolescent to identify what produces more nagging or less; and for the parents, what works or doesn’t work to improve their adolescent’s behavior.
Tip 4: Engage young people in discussions about social media to assess and influence their emerging values.
Here are some suggestions on how to engage youth constructively around social media:
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Plan a family meeting so each family member can share a post or reel that inspired them, e.g., a talented 10 year old musician or singer; or amused them e.g., cute animal antics or a comedy clip; or a thought-provoking post, e.g., screenshots on “How to have a repair conversation after you’ve hurt each other” or a 60-second clip on how to deal with a narcissist.
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To assess and shape the values of the adolescent, notice not only the positive pieces of social media, but see how they respond to “Now let’s share something that disturbed, frightened, or appalled you.”
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Role model a healthy relationship to screens, assuming you have a healthy balance of face-to-face socialization with friends; time with reading books or hobbies; exercising and physical activity.
Social media isn’t going away. Just as we teach youth how to drive safely and use a potentially deadly machine, we have the same opportunity to use social media safely instead of a deadly head-on collision.
Read the entire July blog on David Mee-Lee's Tips & Topics here →
Authored by Dr. David Mee-Lee, “Tips & Topics” is a monthly blog covering three sections: Savvy, Skills and Soul, with additional sections varying from month to month. Topics include Stump the Shrink, Success Stories and Shameless Selling.
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