Q: In my practice, my work with many teen clients becomes a standoff. How can I better engage them?
A: 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.
1. Mirror the adolescent's nonverbal behaviors. One way to establish rapport with teens who refuse to talk is to mirror their body language and postures. This may include mimicking their facial expressions, sitting slouched or sprawled out on the chair, moving your legs in a nervous fashion, and tapping your hands on the chair arms. Inevitably, the adolescent will notice what you're doing and may even laugh, which can launch the rapport-building process.
I once worked with a 16-year-old named Sally who was diagnosed with borderline personality and bipolar disorder. She'd seen seven therapists before me and had been psychiatrically hospitalized three times for cutting and running away. In our first family session, Sally spoke little and wouldn't respond to my questions. However,…