Posted by: counselorcarmella | October 12, 2011

Therapy With Today’s Teens

Therapy With Today’s Teens

Presented at Three Rivers Behavioral Health on Oct 12, 2011

CrossroadsCounselingCenter, (803)808-1800 ext 230, More info can be found at


Adolescence.  The teen years.  They’re not children; they’re not adults. During this time, they’re trying to  establish who they are (autonomy, differentiation.)  This is not always a smoothe process. Counselor  Carmella calls it one massive adjustment disorder. Dr. Michael Bradley calls it temporary insanity. Parents say all the time that they think their teen is bipolar. It can be hard to know what’s “normal.”


Some teens  just want to express themselves with changing clothing preferences,  hair colors, piercings,  or choices in music. For many teens, their social and neurological changes make this a time of risk taking (Sex, Drugs, Rock & Roll). They can get involved in some scary stuff (self injury, sexting or cyber bullying, substance experimentation,  starving themselves, criminal behaviors). Sometimes, reality an fantasy get blurred. When things go really wrong, there’s usually more than one cause.   


Among the most important structural changes in the brain during adolescence are those involving the corpus callosum, the prefrontal cortex, and the amygdale/limbic system. An increase in the neurotransmitter dopamine occurs in both the prefrontal cortex and the limbic system during adolescence. I try and  explain this to parents and teens.  I  tell them, “You can’t always trust your brain.” Adolescents’ emotions may especially overwhelm their decision-making ability.


All adolescents and parents have disagreements. Most are minor. It has been estimated that in about 20 to 25 percent of families, parents and adolescents engage in prolonged, intense, repeated, unhealthy conflict. Lots of power struggles. Parents aren’t always good at picking their battles. If you weren’t around much before,  showing up to be a parent when your kid is 15 and starting to have problems isn’t going to go over well. Rules without relationship = rebellion. Rules + relationship = respect.


One of the big reasons parents often seek out  counseling is to address the stresses and challenges associated with raising an adolescent. These parents often feel confused, angry, and out of control of their lives. For many parents, their child’s transition to adolescence can be complicated by a lack of information for parents and adolescents regarding this developmental stage in addition to rapidly changing adolescent neurology and social environment. I  try to reassure teens and parents that I’ll help them sort out what’s “normal” and what might be more of a problem, and help them figure out what to do.


About 20 percent of youth in theU.S.are affected by at least one type of mental disorder during their lifetime to an extent that they have difficulty functioning, according to a new NIMH survey. The data supports previous findings that mental disorders usually begin at a young age. The research team found that symptoms of anxiety disorders began to emerge by about age 6, behavior disorders by age 11, mood disorders by age 13, and substance use disorders by age 15. The results of the study demonstrate the importance of developing prevention strategies and promoting early intervention for at-risk children and adolescents.


Only about 36 percent suffering with a lifetime mental disorder received help; only half of these teens who were significantly impaired by their mental disorder received professional mental health care. Furthermore, 68 percent of the teens who were able to receive professional care visited a provider fewer than six times during their lifetime. Professional help was highest for teens with ADHD (60 percent), and behavior disorders such as conduct disorder or oppositional defiant disorder (45 percent). For those with mood disorders such as bipolar disorder or depression, 38 percent received services, and 18 percent of teens with an anxiety disorder received help. Fifteen percent of teens with a substance use disorder received care, and 13 percent with an eating disorder received services. It was more common for girls to receive treatment for anxiety disorders and for boys to receive services for ADHD. Non-Hispanic whites were more likely to receive care for any mood or anxiety disorder compared to racial and ethnic minorities.


Therapists have found that engaging adolescents can be especially challenging.  Engaging adolescents in psychotherapy and establishing a strong therapeutic alliance with adolescents require that therapists express empathy and genuineness, utilize developmentally appropriate interventions, address issues around the stigma of seeing a counselor, and increase choice in therapy.  You have to genuinely like teenagers,  be willing to relax a little,  take them seriously, and  hang out with them. You  have to understand their world. Try and  let them know you want to help them get what they want.  If they want more freedom or to get parents off their back, I say I’ll try and help with this. I say, “I’m a safe adult you can talk to, not someone in authority.”


It is also important to spend time discussing the concerns of the parents. Because the effectiveness of family interventions has been well documented with this population, and because parents of adolescents can and often do play a vital role in the course of their child’s treatment, there is important insight to be gained through understanding parents’ unique perspectives regarding the process of therapy. Parents understand that the therapist and teen need a safe relationship, but they don’t want to  be shut out completely and change often involves everyone. Their relationship as the parent needs to be respected.  It is important to help teens and parents communicate and  understand each other better, whenever possible.


Confidentiality can be tricky. When in doubt,  review ethical codes and consult. The ethical codes offer little specificity regarding the discretion extended counselors with respect to confidentiality and minors. The American Counseling Association (ACA, 1995) Code of Ethics and Standards of Practice includes the statement, “When counseling clients who are minors…, parents or guardians may be included in the counseling process as appropriate. Counselors act in the best interest of clients and take measures to safeguard confidentiality” (B.3). Details on what constitutes “as appropriate” while “safeguarding confidentiality” are left open, as is a clear explanation of what constitutes “the best interest of the client.” Age of the teen, family situation, and each individual set of circumstances have to be considered, as well as how much risk is involved in sharing vs not sharing. I tell parents  that no  specific news from me is a good thing and let both parents and teens know that if something that really worries me in terms of health or safety is going on, their  teen and I will figure out together how to let them know.


Some researchers think primarily in terms of risk factors when they study adolescent problems, whereas others highlight the developmental assets of youth. Positive Youth Development helps youth understand what success means to them, and the characteristics and skills of a thriving, productive adult. The simplest way to transfer this philosophy to everyday practice is to think about ways to build on children’s strengths instead of focusing on their weaknesses. PYD emphasizes competence, confidence, character, caring/compassion, and connection.


Another concern about the current generation of adolescents was voiced in The Path to Purpose by William Damon. Damon (2008, p. 8) found that only about 20 percent of 12- to 22-year-olds in the United States expressed “a clear vision of where they want to go, what they want to accomplish in life, and why.” In Damon’s (2008, p. 47) view, too many youth are left to their own devices in dealing with some of life’s biggest questions: “What is my calling? What do I have to contribute to the world? What am I here for?” Damon acknowledges that adults can’t make youths’ decisions for them, but he emphasizes that it is very important for parents, teachers, mentors, and other adults to provide guidance, feedback, and contexts that will improve the likelihood youth will develop a positive identity. Youth need a cultural climate that inspires rather than demoralizes them and supports their chances of reaching their aspirations.  Problems should be taken seriously, but most teens turn out fine.


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