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Why Teens Hate Therapy - Page 3

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The Paradox of Breaking Eggshells

Thirteen-year-old Danielle arrived in my office--courtesy of her mom--and was stinking mad about it. She didn't agree with anything her mom had to say: that Danielle had become more and more angry over the past few months, that she didn't seem to care about school anymore, that she was rude and disrespectful at home. All that was wrong in Danielle's world, according to Danielle, was that her mother wouldn't let her live with her dad.

That Danielle was going to be a challenge was obvious. She was dodgy (would totally ignore a question or comment), provocative, and outrageous. Early on she commented, "In school the other day, my friend and I yelled down the hallways, 'Babies in blenders! Babies in blenders!' It was so funny!" She wore the chainsaw earrings her father had given her for Christmas, as well as a perpetually insolent expression on her face, to make people a little nervous about whom they were dealing with. Danielle would have eaten a newbie therapist alive.

This was a kid who motored through (and over) her family, her friends, her day. She had attitude in spades, but self-reflection, an awareness of the needs of people around her, empathy? Not so much. With a kid as volatile as Danielle, I assumed that any session might be her last. Instead of thinking about the evolution of her therapy, I scouted for little windows of opportunity to present unfamiliar but potentially intriguing perspectives--not asking her to talk about them or consider them or even focus on them--just getting them on her screen for a moment.

On paper, treatment was about reducing her disrespect and defiance at home, resurrecting her interest in doing well in school, and reducing her idealization of dad. In the office, it was about getting her to stop shadowboxing long enough to hear what needed to be said to her, but which almost nobody dared say: that intimidating everybody around you is a hollow victory in the end, that finding entertainment in another's pain is never an attractive quality, and that beneath the tough-girl persona, she was someone worth getting to know.

But she was also the kind of teen who could see through any attempts to "make friends" prematurely by ignoring her bad behavior or pretending not to be dismayed and appalled by it. Any perceived loss of your own integrity is fatal to therapy with a client like this; if there's something you want to say, you'd better say it and own it. Your tentativeness only reinforces her confidence that she has the upper hand in any exchange with you.

Here she is talking to me about her mother, for whom she feels utter disdain and no shame in showing it. "I can't stand my mom's boyfriend," Danielle spits. "He's such a pussy. He actually gets nervous when he tries to talk to me. And he's, like, what, 50 years old or something? He keeps buying my brother and me all these things just so we'll like him, but it's such bullshit." She laughs an unkind laugh, expecting me to appease her with a grin of my own.

Instead I say, "I feel sorry for the guy." Danielle looks up at me, hard.

What? I ask her with my face.

"You would feel sorry for him," she says, with disgust. "Forget it." She reaches into her backpack and takes out some homework to do, presumably for the remainder of the session.

"How come I always have to have the answer you want me to have in order to keep the conversation going?" I ask.

Danielle looks up at me, and with her questioning sneer and slight shake of the head mumbles, "You're so lost."

I keep on. "Yes, I do feel sorry for the guy. I feel sorry for anyone who wants to get to know you because you make them feel stupid for having tried. And I feel sorry for your mom, too, because she seems to really like this guy, but also wants your approval so she can feel that she's doing the right thing. But you see them struggling with all this, and yet you don't help them out. Instead you laugh."

"Why would I want to help them?" Danielle looks genuinely puzzled.

"Wow," is all I manage to say, suddenly very still.

Danielle looks up, disarmed and unsettled by my response. She stares at me for a moment and then turns away.

And there was the therapy--in that brief collision of our two different phenomenological worlds. In hers, being cavalier and mean is OK and even cool, but in my world it isn't. For a few moments, Danielle felt what it was like to be herself in my world, where the rules are different, and it made her uncomfortable. I don't think she'd ever had reason to consider just how dependent she was on having an accommodating context to make her lifestyle work.

If I'd tried to connect with Danielle simply by being understanding or "neutral," the conversation might have gone something like this: When Danielle said, "I can't stand my mom's boyfriend. He keeps buying my brother and me all these things just so we'll like him, but it's such bullshit." I might have responded, "What would you rather him do?" But, by following Danielle's lead in this way, I would merely be condoning her dismissive position. By saying "I feel sorry for the guy," I was getting across the point that her statement wasn't as cool as she thought it was, without directly challenging her. If I'd suggested that she "cut him some slack," I'd basically have been telling her to "be different," which is exactly what all the other adults in her life have done--to noticeably little effect. By saying that I felt sorry for her mother's boyfriend, however, I was sending a similar message, but in a way she couldn't really fight, since I was stating my own position.

When she said "You're so lost" to me with contempt, I might have responded, "What do you mean I'm so lost?" This suggests that, as her therapist, I was more interested in her criteria for how I should be than I was in what was happening between us. It also hints at my reticence to go down the path of opposing her attitude and behavior, with its potential for conflict.

So, what was the therapy, exactly, in that brief collision of worlds? Danielle is like the emperor whose lack of clothing nobody dares point out. In this exchange, without telling her she should change anything about the way she conducts her life, I was able to get the things I thought she needed to hear out into the room:

I don't agree with you.

I'm going to feel sorry for your mother's boyfriend, even if you don't.

Not everyone associates compassion with being a loser.

You control conversations by punishing people for responding in a way you don't like.

You're controlling with your mom, and she tolerates it because you mean so much to her and she's afraid of losing you.

That's not very nice.

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5 comments

  • Comment Link Thursday, 25 October 2012 14:22 posted by RebeccaK

    Teenagers need so much help and are so hard to reach. An article just on boys would be great too. I thought this was a really good start on how to co-exist with a teen, simply to dodge their automatic shutdown response long enough to have a chance at getting them to participate in therapy at all.

  • Comment Link Monday, 22 October 2012 11:35 posted by Dr. Jacobs

    I totally agree with the sentence, "You engage and, if you like what you see in the other person, you connect". This is true with all of our clients but especially with those who are looking for a reason not to be there, as are most adolescents. As therapists, we must be genuine if we are asking our adolescent clients to connect with us and most adolescents are adept at spotting insincerity. Great article. Thanks.

  • Comment Link Thursday, 18 October 2012 17:43 posted by TPG

    The issues with teen boy therapy clients and teen girl therapy clients are vastly different. Boys talk much less readily than boys. The examples in this piece are all girls. That's too bad.