Trying to get in the door with provocative, therapy-savvy adolescents can be a challenging task for even the most seasoned of therapists. Some adolescent clients are masters at putting up the invisible force field while pushing our buttons, or telling us what we want to hear and side-stepping responsibility. Through the years, I've developed several engagement strategies that I regularly use, singly or in combination, that have consistently helped me to establish a therapeutic alliance with even the toughest teen client.

While at first glance, 21st-century adolescents appear impossibly cool--cooler than we could have ever been ourselves--teens today are running hot. They're not just hormonally hot, but hot with cultural forces that have redefined the nature of their consciousness and experience of selfhood. Millennium kids live in a context that spawns fragmentation, what I call a "divided-self" experience: cool and often cruel on the surface, they hide surprisingly healthy passions beneath.

Most therapists learn couples therapy after they get licensed--through workshops and by trial and error. Most specialize in individual therapy, and work with couples on the side. So it's not surprising that the only form of therapy that received low ratings in a famous national survey of therapy clients, published in 1996 by Consumer Reports, was couples therapy. The state of the art in couples therapy isn't very artful. I'll start with beginners' mistakes and then describe how couples therapy can go south, even in the hands of experienced therapists.

By the end of the hour, even when we begin with her raging and sobbing, Jenna usually leaves more cheerfully. She’s much less reactive than when she entered, and, best of all, we’re more in sync. When I’m able to be present in this way, my cooler, more regulated brain lowers the emotional temperature of her hot head. Over the year or so that we’ve been meeting regularly, she’s allowing me to comfort her more and more, using me more effectively for soothing. This is the wonder of what I call Time In.

While we're generally trained to focus on preparing notes that are clinical and objective, confining ourselves to this format severely restricts the creative potential of the process. It's interesting to consider, in fact, that although many clinicians encourage their patients to keep a journal, draft real or imaginary letters to family members, and compose poetry, few clinicians use creative writing in their own work. The act of writing is, in its most elemental form, an act of self-discovery.

On the first day of a clinical placement in my doctoral program during the early 1980s, I was assigned to a counseling center and told by the director that because of unexpected staffing problems, I'd be seeing 20 couples a week. I'd never done any couples therapy, but I did have considerable experience as a family and individual therapist with emotionally disturbed adolescents--a tough, challenging group of clients if ever there was one! So my first thought when given this new assignment was, "After what I've done, how hard can this be?" I plunged in and almost immediately was appalled by how hard it actually could be!

While not all overprotective parents are as extreme in their behaviors as Shyam (indeed, few experience themselves as being obsessive at all), many middle-class families are struggling to decide how much protection is the right amount, even when their children are showing signs of anxiety and rebellion as a result. Whether these families are my clients or my neighbors, overprotective parenting appears to have become the rule, rather than the exception, in today’s world.

I'm flying from Los Angeles to Boston for a week-long meditation retreat, and I'm feeling nervous. For the next seven days, I'll be sitting in silence with 100 other scientists at the Insight Meditation Society in Barre, Massachusetts, at an event sponsored by the Mind and Life Institute, an organization devoted to the scientific study of mindfulness and compassion. The event is unique: when before have 100 scientists, most of whom specialize in studying the brain, gathered together to sit in silence for a week and learn "mindfulness meditation"?

DBT was no walk in the park: it required team treatment, including weekly individual therapy, a year-long "skills training" class, telephone coaching and supportive supervision for the therapist. But it offered clients and therapists alike a way out of chaos--a systematic clinical package that integrated the technical and analytical strengths of behaviorism, the subtleties of Zen training, the warmth and acceptance of relationship-centered therapies and the often undervalued power of psychoeducation.