Case Studies


How to Engage an Angry Teen

March/April 2008


Anger is the normal reaction to teenage defiance, even for therapists, but clinicians typically receive little if any training in therapeutically using the anger that resistant teens provoke. However, a therapist's ability to tolerate and use his or her anger in clinical work can often be the most helpful tool for engaging these difficult clients.

When this understanding of therapeutic anger is employed in the treatment room, the old therapy term joining needs to be conceived in an entirely different, paradoxical way: it now means challenging and pushing back with equal force. With this approach, certain high-risk teen clients—who typically don't respond to softer, more empathic method—feel engaged and understood, since their unmetabolized anger is immediately acknowledged and addressed in the treatment process. The therapeutic use of anger has been a part of traditions as divergent as the "tough love" approach in substance abuse treatment and the well-established modern analytic approaches of Hyman Spotnitz and Robert Marshall.

Admittedly, the approach described in this case study challenges many of the principles of standard therapeutic etiquette. But we believe that "making nice" is doomed to failure when working with too many troubled teens who might otherwise be helped. From the very first moments of the initial session, our goal is to match the teens' negative intensity: to take what such rude and dismissive clients so readily dish out and give…

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