Mistakes to Avoid with Teen Clients

Don’t Walk on Egg Shells

Janet Sasson Edgette • 5/30/2014 • 6 Comments

Rachel, who was 15, was referred to therapy by her family physician when her mother discovered she’d been cutting herself. She offered no resistance to therapy and came to her sessions eagerly, unlike many of the negative teenagers who are referred to therapy. She was funny, warm, kindhearted, likable—and brimming with self-contempt and signs of teenage depression.

I learned from what she told me that while she was sophisticated and circumspect in my office, she behaved quite differently among her friends. She also tended to flaunt her sexuality and flirt strenuously with boys to make up for what she believed to be her subpar looks and personality.

Partly because she was by nature empathetic to other people’s pain (being only too aware of her own) and partly to compensate for her own feelings of inferiority, she became the go-to person for all her friends who wanted to discuss their problems. She was content to absorb their pain in exchange for feeling valued and would agree to things even when she really didn’t want to.

At the same time, she had a reputation for being someone her peers wouldn’t want to cross. Over all this lay an unmovable mass of teenage depression and anxiety like a heavy cloud that she’d been under for years.

Rachel was also very reckless and self-destructive in a willful, intentional kind of way. In the beginning she would tell me about harming herself and her experimentations with drugs and alcohol. I think some of what she told me was a test. So many adults, from teachers to parents and school counselors, had reacted with such urgency and insistence to what she was doing that she’d never had the chance to stop and consider whether she wanted to continue doing it.

I began to understand that one key to working effectively with this girl was in not reacting with obvious alarm, even though everything about teenage depression and her clear anguish seems to clamor for it.

I wanted to affirm Rachel’s essentially benevolent nature and generosity, but I had to do it in a way she wouldn’t find patronizing or gratuitous. I think praise made her uneasy, seeming to make her beholden to a standard that she felt pressured to keep up and was afraid she couldn’t. Once she told me that she didn’t mind the low points of her teenage depression cycles, because she knew that from there it could only get better.

So, instead of openly pointing out to Rachel what I regarded as her instinctive kindness, I just said that I’d been moved by the stories she’d told me about caring for her younger brothers and about getting two girls to stop teasing a third online. I said this simply as an observation and opinion, indicating no requirement for her to respond. Because of her deliberate but reserved nature, my choice of tone in therapy was—decidedly—understatement.

Rachel responded with a shrug, “It’s no big deal.” When I questioned why she presents herself as less than she is, she said, “Because I don’t care,” then adding, “Actually, I think I just really hate myself.”

This is the kind of statement that would make many therapists want to give Rachel a pat little speech about what a good person she is, but had I given this kind of response, it would have made the exchange all about me and what I wanted her to believe, instead of about what she thought and felt. Such a response—essentially denying that she feels what she feels—would also inspire clients suffering from teenage depression to clam up or just get up and walk out. Instead, we sat together quietly and easily for the remaining few minutes of the session.

Topic: Children/Adolescents | Anxiety/Depression

Tags: add | childhood depression | counselor | counselors | cutting | depression | depression and anxiety | negative teenagers | resistance | resistance to therapy | teen therapy | teenage depression | therapist | therapists

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Friday, May 30, 2014 3:08:51 PM | posted by First Name Last Name
silence is fine, but therapist needs to try to understand the reasons she hates herself

Friday, May 30, 2014 5:53:21 PM | posted by grahamb
Portrays a beautiful alignment or "joining" after which exploration for self-image may, at some point, proceed. It is too easy for therapists to feel pressure to move quickly according to 'higher' guidelines - often indirect pressure from grant fund constraints - rather than meet the client at her own place and pace. Also nice awareness of what used to be called countertransference.

Friday, May 30, 2014 8:05:26 PM | posted by First Name Last Name
First commenter: Yep, but I guess the question is when does the therapist need to find out why she hates herself? Some therapies focus on reinforcement of what's right and don't drill down. Sometimes its a matter of "tact and timing" (per psychodynamic work; or, as Yalom writes "Strike while the iron is cold." So many ways to go.....

Friday, May 30, 2014 10:32:30 PM | posted by First Name Last Name
"That's an interesting statement, but we only have a few minutes left. Sometime, when you're ready to talk about it, I'd like to hear your understanding of why you hate yourself." OR "That's an important topic, let ,e suggest that you start our next session with it. If you give me permission, I'll remind you if you forget." This empowers the client, puts the decision in her lap, but doesn't ignore, with seeming indifference, something of importance just so the therapist can appear chilled out. Sol LCSW

Friday, May 30, 2014 10:33:45 PM | posted by First Name Last Name
ooops--- should read "let me" at end of 3rd line

Sunday, June 1, 2014 2:29:53 AM | posted by MARILYN GRUBBS
To Sol: It doesn't appear to me that the therapist is showing indifference, but instead respecting the client's pacing. The therapist will certainly explore this huge revelation in the next session, but I would be concerned that saying that at the end of this session would seem to the client like the over-reacting that others were doing. And my experience is that teens (and adults) often have very little understanding of "why" they feel what they feel, at least until they are allowed to explore it in a judgment-free environment.