Mistakes that therapists often make when working with struggling teens by Doré E. Frances, PhD
Mistake 4: Telling Parents to Back Off
Teenagers almost always come into therapy as well a residential treatment, complaining their parents are too strict and controlling. As a result, therapists who specialize in individual work with teens often get a misguided impression of what goes on at home and frequently advise the parents of teens to be more lenient – to relax their control. In fact, parents who yell and cajole are usually trying to avoid imposing a consequence on their teen. In that respect, they are actually protective and lenient.
Among the most harmful “back off” positions that therapists sometimes take with families is that young people have an inherent right to privacy outside the therapy room. Many parents I see report that their therapist actually criticized them for nosy and intrusive actions. It is crucial to remember that proclamations of privacy by troubled teens are simply ways of concealing things from their parents and maintaining the power position. It is only a teenager who is responsible and doing well who has earned the right to privacy and trust.
Therapists who make parents feel guilty about reasonable investigation into their child’s activities send the message that the teen is in charge. The privacy issue extends to many areas. When parents discuss drugs or sex with their teen, they are likely to hear, “It’s my body and it’s my choice.” Through this logic, there isn’t much that parents can do to help a troubled child. Therapists must address with parents their right to change their teen’s behavior around sex, drugs, smoking and dangerous friends.
All of these issues have to be faced and an understanding reached.
The more information parents have, the calmer and more in control of themselves and their parenting they will be. Parents who have little information about their child’s life are likely to be angry, reactive and inconsistent. The final and critical area in which advising parents to back off is an error is when teenagers are diagnosed with psychiatric disorders. Too many clinicians seem to believe that the best course when a young person is acting aggressively because of a psychiatric problem is for parents to be patient.
The underlying message from such therapists often is, “You as parents don’t really understand about this problem and need to leave it to us experts.”
As parents do less, the problems get worse. Craziness pays off if the child is not expected to respond reasonably. In my work with parents, I always stress they have a right to expect reasonable behavior of their son or daughter and “repressed anger” doesn’t give children the right to be verbally or physically abusive or self-harming.
This affirmation helps parents get beyond the too common idea that if they put pressure on a son or daughter who has a psychiatric disorder, he or she will only get worse, . . . and it will be their fault.
Structure is a healthy form of pressure. As parents feel more like successful family leaders, the negative emotional pressure abates.
Almost all therapists who have worked with teenagers have found themselves stuck in a clinical impasse with an explosive teen and his or her family. Yet it’s never too late to make a paradigm shift and help a family.
First, a therapist must become comfortable with the idea of dealing with power tactics rather than communication skills. Doing so also requires getting used to having teenage clients who don’t like the therapist. The more aggressive a teenager is, the more certain it is that they’ll try punishing the therapist.
When my teen clients call me names I usually say, “You can’t hurt my feelings because I am not your mother. So I’ll keep doing what needs to be done.”
Second, therapists must be ready for greater problems initially. Most therapists prefer their treatment to calm things down and leave people feeling better. This strong therapy may escalate the problems initially, and this is scary for both therapist and family. The therapist must reassure the family that this escalation is expected and will be momentary. Therapists are mostly kindly helpers, so it’s counter intuitive for a therapist who works toward nice outcomes to step toward the fire and heat things up.
However, once a therapist has helped parents take charge and has seen the remarkable positive transformation in a formerly tormented teenager, it becomes easier to work this way. Parents start out saying, “It looks like my daughter’s possessed.” At the end of six or eight sessions, the same parent says, “My son’s back. He isn’t always sweet, but the boy I love is back.”
Professional therapists are there to help individuals and families deal with their problems in a meaningful and productive way.
Using problem-solving therapy techniques, treatments for teens average six to ten sessions, and then if things have not changed an out of home placement may need to be discussed.
When appropriate, professional therapists have no difficulty in working closely with other referring professionals to be certain that everyone involved is working toward the same goal.
This collaborative partnership helps to resolve complex problems for teens and their families more quickly.
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