The transition to adolescence is gradual, of course, so all the information on the preceeding page in "About Children" will apply, at least between the lines. It might be worthwhile, even though your child is in high school or, even college, to read "About Children" so that you may understand the things I am thinking about when I evaluate a teen or young adult and the important issues they face at this age. When a teen needs help, however, our structure is a little different. With children, I request that parents come to the first meeting without their child so that they (and I) can speak freely. With an adolescent, however, it often works best to have parents come with the teen to the first meeting.
Later in the session, I ask if I may see the teen alone. The parents wait across the hall in the waiting room, and almost always, the child begins to pour out their heart. My goal is to allude to the fact that there is hope, even though all family members are pretty sure there is no hope for their situation. There has been too much fighting and too many things said and done that cannot be taken back.
Then I continue, "However, there are a lot of gray areas, and if I have concerns, we will discuss it first and then tell your parents together." That seems reasonable to all, and it gives the message that I will not keep secret from parents anything they should know. Again, deep down, the teen is relieved at this because they want to be protected from running off the rails. What usually happens, if there is an issue, is that the teens tell their parents themselves at home, and then they all come in to discuss it together. Family therapy may emerge as the best treatment strategy rather than individual therapy for the teen. (Please see the "Family Therapy" webpage to get an idea of how that works.) In session, older teens will usually sit face to face as adults do. I enter into their world much like I attempt to do with children in play therapy. With some of the younger teens, we will use the playroom, and the teen may paint, draw, or work with clay. I may administer a behavioral checklist, allowing me to ask follow-up questions. This gives the teen an opportunity to really explain themselves.
THE GOAL: Graduation from High School
(Maria, Incarnate Word HS
Often a teen is anxious to come to therapy; they may have been asking their parents to take them to "a therapist" for a while. However, sometimes a parent will say that their child tells them, "I'm not going to any counselor and, if you make me, I won't talk!!" Here is what I tell parents to say (gently), "As your parent, I am [your dad and I are] responsible for your well-being, and I [we] make these decisions. I will pick you up at school at 4:00." [No further discussion.] (The teen will almost always grudgingly get into the car, because deep-down they want help for themselves and their family.)
Musicals and Stage Plays...
Another issue that is different and of great importance with teens is confidentiality. Most parents agree instantly that you cannot expect a teen to talk freely to a therapist if the therapist is going to blab everything to his/her parents. Yet, by law, parents have the right to know everything that goes on in the treatment of their minor child. Here is what almost always works: With (preferably) both parents and teen present, I explain this rule of law. I then comment on how uncomfortable this would be for the teen. I ask if we could have "limited confidentiality." (I have probably already discussed it with one of the parents ahead of time on the phone.) "What that means," I say to the child, "Is that I would have to tell your parents immediately about any harm to self or others, but would not have to share with them all the 'personal stuff' we discuss." Adolescence does not end abruptly at age 18, as many empty-nesters have found out. Twenty-three is about the age for the child to have crossed over into adulthood, but, of course, it varies from child to child. Some children "hit the wall" in college and need to regroup under their parents' protective wing. Counseling this age individual is rewarding because they want so much to succeed, as they perceive their peers to be doing.
ABOUT ADOLESCENTS AND YOUNG ADULTS
At the appointment, the teen, politely or impolitely, may inform me that he/she does not want to be there, and that he/she will not talk. I say, "No one in this office has to talk if they don't want to. Do you mind if I ask your parents what their concerns are?" I continue, "Now, from time to time, I may turn to you and ask you a question so that your position can be heard. If you don't want to talk, just shake your head 'no.'" Since the truth is, the teen really wants help, and, if I have projected a caring and nonjudgmental demeanor...well, you can guess the rest.
Here is where my work begins. I can truly say that it may not be "a gentle journey," but it is, so often, a thrilling journey of recapturing the love and nurturance within the family. These types of approaches perform the same role as play does for the younger children. The teen is "checking me out" by how I respond to their answers. Am I kind and respectful of the, well, angst and drama that adults tend to poo-poo? It is as real to them as the "serious" issues that adults bring to me. Am I attempting, as best I can, to understand the teen's point of view? They can feel that, if I am successful. Technically, the parents have no right to know what goes on in their child's therapy after they are 18, but in practical application, the children want very much to have their parents included so that the parents can understand what they have been going through. The goal is to get clarity for all and to attempt ways to fix it. Some who do not go to college, or those who may be unable to finish college at that time, may have trouble taking up the adult badge of honor of making their own living. There may be a poor employment history even after graduating from college. There may be reasons for this that a psychologist can identify.
Dr. Horn worked with children and adolescents and their school and family issues for many years. She currently sees only adults, specializing in individual, family and couple counseling. She has been a Medicare provider since 1998 and has special expertise in counseling families with an aging parent, and individuals and couples in their later years.
Her work with children and adolescents greatly informs her work with adults and families. Every adult and elder was once a child and an adolescent. To have the background in these developmental stages greatly informs the understanding of an adult who is seeking help at later stages of life.
For background information, you are invited to read about how I approached work with children and adolescents: