Following our last collective post on therapy for depression, we are continuing our ongoing series of conversations with a focus on therapy for teens. How do we–as a practice and as individual therapists–approach working with teens and what would we like parents to know? What is different about the experiences of NYC teens? And how can therapy create a safe space for teens?
Matt: I think the five of us unanimously have a soft-spot for doing therapy with teenagers. This must be pretty unusual. I know a number of therapists who feel great about working with just about anyone but teens.
There’s a lot that bugs me about the way teenagers are talked about in the media and in popular culture. There’s a sub-genre of television commercials, for example, that seem to put them down left and right. These commercials present caricatures of teens complaining about mom washing their jeans the wrong way or finding out just before they board an airplane that there’s no internet service where they’re headed. Teenagers are inevitably cast as whiny, unreasonable and bumbling while their concerns are related to just as superficially.
I think teenagers have a tough deal. That’s not to deny that they can’t also sometimes be a pain in the neck or spoiled. But we all see, in our therapy with teens, the way their concerns–much like in these commercials–get tossed aside. Taking teenagers seriously is a huge part of the work in therapy.
I’d like to ask two questions: First, what interests you about doing therapy with teenagers? Second, what have you learned from that therapeutic work that you wish parents and teachers (and the world) would understand about what it means to build meaningful relationships with teens?
Heather: Adolescence is such a tough time because teens are really stuck between a rock and a hard place. They have grown beyond childhood, but they are not quite adults. They are in a process of self-discovery–learning who they are and how they want to exist in the world. While doing this, they are engaged in a power struggle with the adults in their life, as families try to find the right balance in how much space they can safely give them. This journey to find equilibrium can make teens quite prickly (and we all known hormones don’t help).
I absolutely love working with adolescents because you have an opportunity to make a huge positive impact on both the teen and the family. You get to help guide the teen in their process of self-discovery and help them solidify their sense of self. You also get to help the family as a whole navigate this tough time and find the right balance of closeness while respecting the teen’s desire for autonomy.
Teens often get a bad rap because of this initial prickly demeanor. I find that if you ignore or almost come to expect the prickliness and just see it as an expression of this struggle, it often melts away. Once an adolescent sees that you are on their side and are not trying to threaten their independence (but rather helping them get better at being on their own), he or she will open up. You will get to see all of the wonderful traits they have to offer.
Rachael: I love getting to know teens. Echoing Heather, adolescence is such a tough time. I find that while, at first, teens might have one or two things to work on, we usually come upon so many different topics and processes that they want help with. These topics range from dealing with their parents, school, siblings, friendships and romantic relationships to figuring out, being able to question and understand how the world works in a functional and emotional context.
When I first meet a prospective teen client, it’s a staggered process. I typically meet briefly with the parent, then the teen and finally, the family in therapy. We all have to work together to make this process function. And it often looks different than parents and teachers might think. Like all therapy, it is a process.
Working with a teen in therapy begins with one-on-one sessions because we are the ones who will be doing most of the work together. I want parents and teachers to feel free to be curious about the therapeutic process. They should use this curiosity to lean into the process that teens need to grow, develop and create.
In therapy with adolescents–as Heather said, they need to know their autonomy and independence is not threatened. This means establishing that the therapy room is their space. We aren’t going to ignore that their parent or teacher most likely initially brought them into therapy. However, we have to create a space that is theirs. What do they want to talk about? Work on? Grow around? Who do they know themselves to be and what do they struggle with? What do they have trouble even verbalizing?
This is a “safe space” for teens to explore questions about both the tricky task of managing the world in adolescence and growing with emotional health. It is hard as a parent to not be an active part of this space. Just like if your child was attending tutoring, violin lessons or SAT/ACT prep, it is important to respect the space, learn with the pro how to “speak teen,” and move in growth. Of course, as you, your child and therapist work together, we–as a unit–will address areas of concern while respecting autonomy, safety and confidentiality of this therapeutic space.
Matt: So much of what I think about with teens is the importance of taking them as seriously as we would anyone else. It’s so easy to dismiss a teenager–it’s culturally reinforced to brush off their complaints or frustrations as trivial. At the same time, teenagers do still need guidance. Especially practicing therapy with teens in NYC, we see so many teenagers who are in over their heads with drugs, abusive relationships, sex, etc. The great paradox of adolescence is that teens are adults in so many ways–they can navigate the city and have a good deal of freedom. They’ve seen drug deals and watched friends and strangers smoke pot. They’ve been exposed to sex and their bodies are developed sexually. But these things are also still new and no teenager is prepared to deal with them on his or her own. It seems to me that a huge challenge is balancing both sides of this–finding a way of saying both “Yes, you’re not a little kid, you’re not naïve and you are dealing with serious issues;” and, “Hey you’re over your head. You need help with this. There are things going on in your life that you can’t handle by yourself. Let’s figure out how you can let others and me in.”
How do you think about these two issues while doing therapy with teens in our practice? What experience have you had with teens in New York that are over their heads? How do you challenge teens to let you in while still respecting that they aren’t little kids?
Rachael: Matt, I like the questions you’re raising. I find there needs to be a healthy balance in the therapy room of: “Ok, I respect you and you’re not a little kid,” and “You’re in over your head.” I often see teens and parents taking a hands-off approach. “They’ll figure it out!” “It’s just a phase.” “I’ll get it together if I just try harder.” “You wouldn’t understand. I’ll figure it out on my own.” But what we need in that phase of life is help–someone to talk to and work things out with.
I find New York teens experience a lot very early in life. The city is at their fingertips and yet they’re still not totally able to be self-sustained. I think that this gets under-acknowledged so it becomes hidden. I find that teens in NYC are often in over their heads with schoolwork, social dynamics, college applications, drugs, sex, relationships and isolation. There is a LOT of pressure to perform perfectly or that things just happen. And when there is a lot of pressure we either release or hold in. I think teens either don’t know how to release and will release/or hold in with isolation, drugs, sex (consented, unconsented or risky), alcohol, avoidance and anxiety.
I led a group of teens and we covered everything. They needed someone who was both street smart and honest. They also needed a place where they could not hold back, be messy, not know and get both emotionally supported and educated.
We made space for that and as we built, I agreed that I wouldn’t freak out on them. We signed-up to create a safer life, point out when things could be different and push them toward that. I noted they were making some pretty risky moves: not thinking through their safety in the day or night, being places too late, being with folks way older than themselves, feeling pressure and ambivalence about education and experimenting with defiance. I was a therapist and a safety educator for life–someone who was curious with them, would call them out and reorganize and educate them about a different way to approach life.
I asked them to bring in questions to me in order to seek out an answer rather than a lecture. I asked them to think about what they wanted help with or if they wanted my opinion about when they were “in over their heads.” They listened. We built a type of therapeutic relationship and mentorship where they could lay out the scary unknowns that make up adolescence.
Matt: I like the idea that teens in New York growing up fast, having more independence, being exposed to more is a real phenomenon. It does really affect what it means to work with teens in therapy. The subway is a big liberator and neighborhoods are so walkable. Kids see and experience a lot of everything. I’m reminded of the upside of this–not being dependent on adults for a ride, being able to more casually connect with friends and being able to make choices about where you go and when. What seems vital is that parents match the opportunity teens have with challenging them to develop. You’re not going to be able to keep your teen in NYC from being exposed to drugs, for example. It forces the issue so you better sort out how to talk about it in meaningful ways. That’s hard.
Kiran: Teenagers keep me honest. I appreciate working with teens because they usually keep things real. I’ve learned that teens want to be respected like all people. I work hard at showing them respect for their ideas and if I fail at this, they usually let me know somehow. I have found that they have a wealth of knowledge about their life and the world around them. If given room to explore, they can usually come to most of the answers to their life challenges. I believe that there are different ways to connect with teens in therapy. Not all are interested in traditional “talk therapy.” Perhaps we can talk over a game, a walk or even, some coloring.
Building meaningful relationships with teens requires an honest look at my own ideas on teens. Do I value their input? Do I think they have wisdom and knowledge? Do I respect them? Do I consider them to be engaged members of society? Yes.
Matt: Thinking, Kiran, about the sort of b.s. detector teens have, it’s so true. Why is that? I suppose that to build a meaningful relationship with a teenager demands that you will be able to handle that–invite it really. What I’m thinking about as well is what is it about all five of us that allows us to be able to handle that. I’ve literally never worked with a teenager who didn’t at least sometimes look at me with a “what kind of sh** are you trying to pull, man?” look. It’s a kind of accountability–an openness to being challenged. I imagine it makes us good therapists period, even with folks who have grown past the age when they feel they can call out the b.s. like a teenager can. I think my patients know I’m open to being challenged, called out on taking a shortcut, not taking something seriously enough or not listening as deeply as I intend to. At their most difficult, teenagers are being at their most honest.
Karen: I think that we all have a pretty serious respect for teens. My work with teens has mainly been with teens living in really tough situations such as the foster care system. Even in these painful situations, it is the passion and intensity of teens that I have always felt a real admiration for. Building with that can be a really moving process. Because teens are often pushing for more independence, there is a complex restructuring of the teen’s family that often needs support. Establishing a new structure in the family is serious work and can raise new issues for families, as well as trigger the emergence of old issues. Conversations about racial and ethnic identities and sexuality are very important as teens are thinking and developing in these areas. Parental buttons get triggered by all this. Therapy can be a really supportive place to sort this out and get the teen and teen’s family on a healthy path. I see adolescence as an important time of challenge–not just for the teen but also for the family.