Counseling isn’t working

When should I place my teen in a facility to get help?

So often it feels like an extreme measure to remove children from their homes and place them in a facility that might be in a completely different state.

There are no well-established guidelines for placing your teen in residential treatment. Generally speaking, teens enter residential treatment when their needs are too intense to be managed with outpatient counseling.

iStock 000007761349Small 200x300 Counseling isnt workingAfter talking with thousands of parents, what we hear most often is…

  1. “Outpatient counseling isn’t working.”

Parents frequently report that their teen seems to be spiraling out of control and increasing the intensity and/or the frequency of counseling has done nothing to stem the tide of distress and dysfunction. No matter how many opportunities they have given their teen to change, counseling, rewards, punishments have all failed to change the direction of their teen’s life.

  1. “Our family has had enough.”  “He was staying with his uncle, but he has worn out his welcome there too.”

All of the available emotional resources for support from friends and family have become depleted or drained.

  1. “I don’t understand it… he has a great life… I don’t understand why he is so depressed or angry or apathetic or lazy or failing….

Parents often experience confusion or ambiguity as to what the teen might be struggling with and are looking for greater insight and clarity.

  1. “We have to lock our bedroom door because he has stolen from us.” “We are afraid to leave her alone.” “She was grounded, but she just shoved me aside to run out the door.”

There are safety issues, such as escalating levels of substance misuse, self-injurious behaviors, or physical acting out that may be reduced in a controlled treatment milieu.

 

%name Counseling isnt workingAt Shelterwood Academy we can provide round the clock observation in a controlled environment. This level of stabilization helps clarify behaviors or emotions and allows parents to regain control of their homes. Reducing the impact of the teen in the home often protects siblings and enables parents to re-establish their relationships with one another. This renewed strength empowers parents and many families have reported to us that they felt the time out in a residential setting was critical in their own lives. The stress of worry, self doubt with regards to parenting skills, and the anxiety about their teen’s future were all greatly reduced while their teen was in residential care.

Don’t Back Off

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. 

Screen Shot 2015 06 02 at 1.12.12 PM 300x259 Dont Back OffAmong 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 transformationScreen Shot 2015 06 02 at 1.08.52 PM 300x195 Dont Back Off 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.

Check out this important video on Fear

Errors that Therapists make

Taking back authority in the counseling office and in the home

Most therapists I know agree that teenagers can be among the most difficult clients they see in their practice.

iStock 000007761349Small 200x300 Errors that Therapists makeThey often refuse to attend sessions, refuse to speak when they do attend, swear at parents and therapist, and storm out of the room when they hear things they don’t like. Difficult teenagers often argue head-to-head with adults and professionals using arguments such as, “I’m not going to give them any respect if they don’t give me respect,” and “It’s my life.” At times such teenagers have thrown objects across the office. One particularly aggressive thirteen-year-old girl threw her high heel sandal directly at her therapist while hollering, “I’m glad I’m not one of your kids!”

Some teens are so direct that they come out and say, “There’s nothing you (the therapist) or them (their parents) can do about me.”

Any therapist treating domestic violence takes one look at a husband who is dominating and abusing his wife and recognizes that he exercises power over her. Yet, when a teenager threatens, dominates by shouting and imposing guilt and controls their parents by threatening to run away, most therapists fail to realize that abuse may be going on. Adolescent and preadolescent behavior begins at younger ages as our culture educates them more rapidly. Parents are walking the fine line between being authorities / parents and friends with their children. However, this tightrope is precarious and requires a lot more knowledge and patience than, “spare the rod and spoil the child.” As psychologist David Elkind pointed out decades ago, children are growing up more quickly and losing their childhoods too early in our fast-moving society.

As teenagers become adult-like at earlier ages, they see themselves as “equal” to the adults. Our society isn’t teaching them the distinction between being of equal value versus having equal authority as adults.

Teens are extremely vulnerable to believing that they can handle everything and don’t need adults.

They are struggling to take control of their lives as parents struggle to give them that control only as they’re ready to handle it. There’s a natural power struggle. So, how does an excellent therapist treat a struggle between a teenager and their parents?

Do they ignore the power issues and treat everyone as equals, or understand the need for order in a child’s life through support and leadership? Therapies that advocate support without leadership fail, giving teenagers too much control, in my opinion.

There are four common errors that therapists make with teenagers, that Doré E. Frances, has come across in her practice. They are surprisingly simple to grasp, and they always make matters worse:

Mistake 1: Courting the Teenage Client

Mistake 2: Falling Prey to Therapeutic Tunnel Vision

Mistake 3: Improving Family “Communication”

Mistake 4: Telling Parents to Back Off

We will discuss the first mistake that is often made by inexperienced counselors or weak therapeutic boarding schools. Courting the teenage client can often begin with the initial phone call from a parent.

The first words out of a parent’s mouth often are something like, “The counselor at the school said we need to bring Tammy in for family therapy, but Tammy says we’re the crazy ones and she won’t come in. She said she wouldn’t talk even if she did come in.” In the residential setting, a parent might be concerned that while their teen needs help, he or she would never allow it to happen and would possibly runaway or act out before they could get them to the facility.

This is the number one power tactic teenagers use to keep therapy from happening.

Weak therapists accept this story, suggesting that in order for someone to change they must be willing right from the beginning. They quickly empower the threat of the teen by saying, “oh well I guess there’s nothing to be done when their child won’t cooperate”. When this is the message to your family the therapist might as well say, “Sorry folks, you better get used to your daughter running your family.”

The best therapists, I have come across, when confronting this situation, tell parents on the phone that they treat kids who “won’t cooperate” all the time, and that they, the parents, must decide whether therapy is to happen.

Even in therapeutic boarding schools, teens try to avoid counseling. We recommend that our counselors tell the teen that the session is scheduled and they are expected to be there, and if they are not, the grown-ups will meet anyway. We also coach the parents, who are our clients, to point out to their teen that the adults will be talking about them and making decisions about their life. Most kids come to the first session after hearing this.

When they don’t attend, the therapist agrees with the parents in the first session to change something major at home, and when their adolescent gets angry about the change, to simply say, “Oh, we decided that at the therapy session.”

Teenagers almost always come to the second family session. As long as parents are reactive, and feel helpless and hopeless, the young person wields the power, dominates, controls, and simultaneously suffers. Another way that many therapists court teenage clients and make matters worse, in my opinion, is by according them the same treatment status as adult clients. The prevailing belief–not supported by law–that teenagers are entitled to a confidential relationship with their therapists leaves a teenager who is drunk on power thumbing their nose at the parents. A lot of therapists operate under the same standard of privacy with their teenage clients that they have with adult clients, which they feel requires them to withhold critical information from parents. Many angry parents come to our program with this complaint, stating that their teen’s therapist was withholding important facts, such as the teen’s sexual activity, smoking, drugs or criminal behavior, from them. Confidentiality in families is held within the family and not by individual members. Therefore, the therapist has latitude to share whatever needs to be shared.

The best therapists make it clear that they are closely involved with parents and they will use their judgment as to what they share with them.

After all, what’s the point of a teenager telling a therapist they are using drugs when the therapist can’t help the teen discuss it with the parents and find a solution? Creative therapists invite teens to withhold information from them until they decide they can be trusted. I find that teens then share sensitive information with their therapist even though they don’t give them a guarantee of confidentiality.

By Doré E. Frances, PhD

Education Consultant

Compassion Fatigue

iStock 000013332733Medium 300x200 Compassion FatigueRecently, I spent a few days at the NATSAP conference on behalf of Shelterwood. I was fortunate enough to hear John Townsend speak on boundaries. He shared about the cost of not keeping healthy boundaries for parents and care workers (compassion fatigue). Here are a few of the thoughts that I felt were particularly helpful.

Teens Need Boundaries

Adolescence is an important stage for kids to push against parents in an effort to build autonomy. Without boundaries, teens are more likely to become depressed, anxious, angry and detached. Of course, it is not easy to put boundaries in place and maintain them. Boundaries can feel like battle lines as teens love to say, ‘no,’ but often struggle hearing the word ‘no’ themselves. Yet we all know, as successful adults, that hearing the word no is a part of life. It is critical to be able to deal with our emotions when someone says no to us.

Boundaries will feel harsh if they are not built with love and empathy. But make no mistake; there still needs to be a line. Without boundaries, teens can become aggressive, believing that the world is their ‘property.’ Other teens that have experienced boundary violations may become depressed and allow others to trample on their boundaries sexually, emotionally, or physically because they have come to believe that they have no ‘property.’

If not creating boundaries leaves our kids or clients struggling into adulthood, then why is it so hard for us to maintain clear boundaries? Why might we so quickly give in to the demands of our teens, friends, co-workers or spouses?

  1. Afraid of losing the relationship

Relationships are critical to each of our lives and they are often what keep us going. It is easy for us as parents or counselors to build entitlement within our kids or clients because we are safe for them and we feel special when they seek us out. So we might give them extra time, money, or praise when what would actually be better for them is to hear the word ‘no.’ They need to hear no even when giving them a longer counseling session might seem useful, or when giving them their full allowance even though chores are undone in order for them to buy that special pair of pants that will generate a hug and a smile. Teens become entitled so quickly when boundaries are not kept. It is so easy to drift from compassion into co-dependency. When we are afraid of losing a relationship with a distant teen, friend, or spouse, he or she quickly has leverage on us and this is a dangerous power for anyone to have, especially teens. In order to combat the need for your teen’s approval, try to create a ‘life team,’ a group of adults that can support and encourage you outside of the home. Don’t rely on your kids to nurture you, lest you give them too much power.

  1. Conflict Avoidance

Each of us learned how to deal with conflict when we were nine years old. Take a moment to think back to those young years in your childhood home. Maybe you learned how to explode with anger, change the subject, or laugh. Each of these techniques does not really deal with the conflict. The inability to manage conflict leaves you weak in the face of opposition and trying to defend yourself when you actually do say ‘no’ in order to create a boundary around a behavior. Townsend encourages people to role-play in an effort to change the neurology in the brain. It is critical that we as parents and care givers learn to confront conflict and become able to embrace the emotions that come along with saying ‘no’ in order to win the long- term battle of autonomy.

  1. Fear of Failure

We create a fragile teen when we don’t think they can handle boundaries. They become more insecure when we fail to provide the security of rules and follow through. Teens need to learn how to adapt to the difficulties of the world and that failure is part of life. As parents and counselors, we often perceive struggling teens as weak and incapable of dealing with failure. We might unconsciously believe that their drug addiction, depression or anger is the result of difficulty in their lives, and that if we can just remove the difficulty, then they won’t need to self medicate by cutting their arms, getting high, or acting out sexually. When we see them as fragile, we tend to compensate for their weaknesses and enable them to maintain these behaviors. Trying to keep your teen happy and safe will wear you out and fail to teach them how to survive on their own. So often we tiptoe around our teens when they struggle with depression, anger, anxiety, and/or learning difficulties that we actually build greater insecurity in them and continue to perpetuate a dependence on us. While this might make us feel needed and important in the relationship, we are actually just enabling co-dependence.

If you struggle to create boundaries with your teen, ask yourself these four questions when they make a request for your help:

  1. Is this something that they can do for themselves?
  2. Do you have the resources to help?
  3. Will you feel cheerful or resentful after helping them?
  4. Is the outcome going to build autonomy or dependence?