Mandatory: Making it Worthwhile

“I don’t want to be here. I’m not going to say anything. I don’t know. Why should I talk to you?” You may find yourself thinking or saying thoughts like these in response to pressures to engage from a program, family, or friends. Perhaps you aren’t ready to share what’s brought you here, or what the challenges are that you are facing in this moment. Perhaps you feel like your personal freedom has been taken away, your choice to participate of your own free will. Understanding that you may feel angry, resentful, or withdrawn, please consider the following in support of getting the most out of something that is identified as mandatory.

Blocking or Belonging

You may come from a different background or hold different values from those you come into contact with, so what brings people together in this process? Shared experience around homelessness, financial instability, substance abuse, conflict in relationships, or a lack support can help one feel less isolated and alone in their experience. Although each person’s story is their own, the feeling of connection to others and belonging can go a long way in having an experience feel less mandatory and more voluntary. When you observe others engaging in the program or group, you may find yourself asking:

• Do I feel I can relate to others in the group?

• Do I feel this community is healthy, approachable, supportive, and willing to engage me in this process?

• Do I feel supported by staff and helping professionals to achieve my goals?

• Do I feel comfortable opening up and working on myself in the presence of others?

For many involved in Alcoholics Anonymous (AA), they speak of the community as an equally powerful element as the 12 Steps in to their ability to actively participate in their own sobriety. Due to the friendships they make, they feel they have a connection to others in ways that feel encouraging and uplifting in moments of challenge or struggle.

Building Perspective

In addition to identifying a supportive community, how you approach the experience for yourself matters. Do you have realistic expectations of what you can accomplish both short and long term? Can you set yourself up for success in your work with others? When starting this process, it is helpful to understand basic needs as the foundation for progress. Educating yourself on how basic needs such as food, safety, and shelter provide the foundation of stability gives you permission to organize goals for success. Abraham Maslow, who identified this relationship in the Maslow Hierarchy of Needs, emphasizes that only when basic needs are met can one focus on higher work around self-esteem, sobriety, and relationships.

Relational Rapport

When exploring relationships, research tells us that therapeutic rapport accounts for more than any other factor when measuring progress towards goals set in therapy. In other words, the therapeutic relationship, unconditional positive regard, and power of feeling seen, heard, understood, and supported has positive results on goal progression. If your past experience involves trust or mistrust, being aware of how therapy and/or relationships have helped or hindered you in the past can put current resistance and reluctance in perspective. A few questions that you may find helpful at ask at the first meeting with a helping professional include:

• What kinds of clients have you worked with before?

• How do you work with people who are uncomfortable with therapy?

• What do you do with feedback from clients?

• What can I expect from working with you?

All of these questions encourage healthy discussion around the therapeutic process and can provide insight into expectations and measurable goals when engaging a helping professional in your own growth process. 

Mandatory can feel restrictive and stressful when viewed as a loss of control or freedom. What better way to reframe it than to ask yourself, what can make it worthwhile? 

“If you change the way you look at things, the things you look at change.” Dr. Wayne Dyer

Engaging Adolescents and Caregivers in Family Therapy

“Do I have to do family therapy?”

Yep, that's such a common question I get from my adolescent clients at the start of therapy. Here are some other common questions and statements a therapist may receive in regards to parents and caregivers being a part of an adolescent's therapy process:

"So how much are you going to tell my parents?"

"I hate these family things; i just feel so awkward."

"Do I have to be in the room when you talk to my mom/dad/guardian?"

“I’ll talk to you, but I will not talk to my parents about this!”

“Why try, nothing is going to change!”

“They/she/he just doesn’t understand me.”

Do any of these sound familiar in your therapeutic work?

When reflecting on these common initial responses and questions about family therapy, it has been my professional experience that I see a clear pattern of fear, lack of trust and shame arise as barriers to adolescents getting their needs met by their caregivers. Additionally, many adolescents seem to have a common misunderstanding (and caregivers too) that family therapy is about pointing fingers and being the “problem” of the family. So with this in mind, I’m excited to share some strategies I use to build rapport, connection and trust with adolescents to empower them in engaging with caregivers in family therapy.

1) Be Transparent! In other words, BE REAL with your client. Adolescents are smart, clever and can read through any BS or tip-toeing going on in the room. I give them the direct and transparent version of confidentiality and expectations of what therapy entails. 

“I know you may or may not be wanting to communicate certain things with parents, but I want you to know what I must report immediately. Any safety concern including suicidal ideation/planning, abuse, neglect, witness to violence, and self-injury must be reported to caregivers or appropriate authorities. With that being said, there may be things that come up that you are not open to sharing but would be beneficial to do so in order to get your needs met from your parents/guardians. When this happens, I want you to know I will challenge but not force you, and together we can figure out the best way to schedule a family session around it when you are ready.”

2) Build trust immediately: I know this one is a given, but I start with every first session letting my adolescent client know that I don’t expect them to trust me right away in an effort to ease any tension or pressure someone might feel.

“I want you to know that I don’t expect you to trust me right away. Trust takes time and is earned so that’s exactly what we are going to do. We will take time to get to know each other. You can ask me any questions you need to about myself or the process. I’ll let you know if I can’t answer it for any reason. And I want you to know if I ever ask or discuss something that you are not ready to answer, you say so, and we will use the time for what you are ready for and need. This is your time and space, and I want you to feel safe.”

3) Share the responsibility and “workload”. It’s essential to dispel any myth or belief with the adolescent and caregivers that a) they are the problem child and b)your job is to “fix” them in some way. Again, this is where I use transparency in the first session or parent consult (as well as throughout ongoing treatment) to set clear expectations for all involved.

To caregivers: “I want you to know that if i’m working with your child, I’m working with you also.  In many ways, this work can be equal or more for the parent.  My job is not to “fix”. Rather, i’m here to provide assessment, education, skill-building and a safe space to process and build awareness so that you and your child can more effectively communicate, understand one another and connect in a meaningful way to address the barriers.” I always let adolescents know that I’ve had this conversation with the caregiver(s) as well so they know it’s a joint effort.

4) Empower the adolescent voice. I like to give my adolescent clients as much choice and opportunity to lead as possible when it comes to parent involvement. Here are a few different ways, I frequently go about this in session:

“Would you like me to check in with mom/dad alone or with you it the room?”

“Is there anything you’d like to share with mom/dad/caregiver from our session today?”

“Is it alright if we bring mom/dad in at the end to share any skills we worked on so they can practice it too?”

“Is it ok if I emailed mom/dad about (a specific one or two things from session) so that they can be more aware and better understand what you are going through or how to support you?”

“Is there anything you want to teach mom/dad today?”

“Would you like me to explain (specific pattern or skill) for you to caregiver with you in the room?”

“Would you want to do a family session with mom/dad on this? If so, when do you think you’d like to do it?”

5) Parent Coaching Sessions are a must! Along with letting parents and adolescents know that this is joint work, I let them know that some sessions will be just with the parent(s). I am transparent with the adolescent and parents about the purpose of these sessions from the start.

“These sessions with your mom/dad are NOT to report all that you’ve said or processed in session. Instead, they are an opportunity for you parent to explore their own barriers getting in the way of supporting or connecting with you. I will always let you know when i will be having a session with you parents in case you have any questions or anything you would like me to share or work on with your mom/dad.”

To caregiver: “These are sessions where you can explore challenging emotions, patterns, behaviors that you are struggling with that might be acting as barriers to your relationship with your child. The main goal is to empower you as a caregiver and strengthen your relationship.”

6) Provide Outside Resources to Caregivers and Adolescents from the start.

At the end of an initial session or consult, I provide at least one book and internet-based resource that will help parents get a head start on some of the topics and ideas we will be addressing in therapy. Throughout the process, I continue to provide both the caregivers and the adolescent ongoing supports based on what is coming up in therapy and what the family barriers may be.

Some of my favorite resources are:

Ted Talks: Especially for the adolescent and caregiver to watch together at times.

Wellcast videos: Here is one of my favorites, but they have them on all topics! I often show to adolescent in session and send to both caregiver and adolescent after session. https://www.youtube.com/watch?v=UMIU-Uo8cZU

Phone apps: mood meter, calm.com, Headspace are just some of my favorites.

Books: there are so many; here are a few favorites

The Gifts of Imperfection, Daring Greatly and Rising Strong by Brene Brown (also has great ted talks to introduce the concept of vulnerability and shame)

Whole-Brain Child, Yes Brain and Brainstorm by Dan Siegel and Tina Payne Bryson

Emotion Focused Family Therapy resources: This includes caregiver webinars and in-person workshops, book recs, links to articles, etc. All greatly support parent coaching and family work. http://www.emotionfocusedfamilytherapy.org and http://www.mentalhealthfoundations.org are two helpful websites.

Review/summary emails: These I send with adolescent permission to specifically review a skill, idea or new strategy that would be helpful for the caregiver or adolescent from session. This way, they can refer back to it as needed.

Engagement with adolescents and parents can be difficult at times, but I have found the more i’m able to focus on empowering families and setting clear expectations of what family work is and isn’t, the more willing adolescents and caregivers are to engage in the process. My goal is never to be the one the adolescents trust or “go to” the most, it’s to help them build that with their parent(s) or caregiver to be able manage their challenges and barriers in life in a sustainable and connected way.

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Guest post written by Meaghan Burns Sablich, LCSW

Meaghan Burns Sablich, LCSW is a Licensed Clinical Social Worker, Licensed Colorado State School Service Provider and clinical supervisor with 10+ years experience in the field. Meaghan received her Masters Degree in Social Work from the University of Denver with a concentration in Families and Children. Meaghan has worked in a variety of therapeutic settings including inpatient hospital, residential treatment center, day treatment center, schools, non-for profit organization and private practice. Areas of clinical focus include: depression, anxiety, ADHD, eating disorders, family therapy and parent coaching, grief and loss, school/learning concerns and self worth work.

Engaging Teens: Staying Current in their World

Teenagers may be reluctant to engage in therapy due to stigma, stereotype, or pressure from their parents or guardians to “get it together,” stop a behavior, or cope with the stressors of their lives. Regardless of why they come into your office, you can support them in ways that allow them to feel safe enough to access emotion and engage fully in their own therapeutic process. Many teens have engaged in therapy in the past and few have positive things to say about their experience. A valuable question to ask in building rapport could be, “what did you absolutely not like in therapy before? Anything you want to make sure I don’t repeat?” This engages the teen to speak plainly about what their needs are in the therapeutic relationship as well as feel heard by you in asking their preferences, a client-centered approach that assures them of their active participation in the therapy process.

“I’m not your _______.”

Helping a teenager feel heard is one of many valuable tips in building rapport. Another element at intake to consider is your role in their process. It is important to establish healthy boundaries and clarify your role with teens prior to engaging them in ongoing work. Your explanation may go something like this: “I am your therapist which means I’m here to support you. I’m not your parent, teacher, friend, or probation officer as you may have those in your life already. My job is to be someone you can talk to who is non-judgmental and supports you in finding solutions to things that are stressful in your life right now. How does that sound?” By naming your role and asking for feedback, you are establishing both a professional connection and expectations of your work together from a place of respect and unconditional positive regard.

Keeping Secrets

Privacy is important to teens as they build their identities, form new relationships, and begin to seek autonomy in their world. Exploring the limits of confidentiality is vital to supporting them in their process in that they seek clarify of what truly is confidential and what is not. Many teens may be aware of your role to keep them safe if they were to disclose suicidal thoughts or threaten to harm someone else. But do they know you are a mandatory reporter who is required to report any abuse? Do they understand you may monitor the age of their sexual partners to make sure they are of legal age to consent? Do they know what self-harm looks like in working with you? Do they understand the implications of experimenting with drugs and alcohol and how you many need to respond if they are driving under the influence or violating probation? Having conversations about these limits can support a teen in knowing what is truly private and can allow them to more fully be themselves in your office in having a clear understanding of the consequences.

Recipe for Success

Now that you’ve gotten the formalities out of the way, what are some ideas for how you can connect with a teen? It is recommended you start by getting to know their interests, friends, and goals. One favorite rapport building intervention is having a teen build a playlist of their life, identifying songs that represent them and their experiences. They can discuss the songs in detail, allowing the therapist to build rapport and gain insight into their life. My personal favorite exercise is a ‘recipe for success’ that involves colored sand art and a teen’s ability to identify what they need to be successful in their life such as love, independence, time with friends, etc. They build a recipe of these elements as they converse with you and the art serves as both a low-risk therapeutic activity and a symbolic reminder of their success that they get to take home.

Below are other therapeutic intervention ideas that could be considered when working with a teen to build rapport:

• Life mapping their interests and relationships
• Vision boarding their wants, needs, and goals
• Self-portrait in paint, clay, pencil, etc.
• Family tree or genogram

Remaining ‘In the Know’

Teens will be the first to give you feedback on how they think therapy is going, but only if you encourage them to have a voice. Once way to do this is to support them in speaking how they wish to, whether it be slang, cursing, or other modern expressions of communication. Encouraging a teen client from the beginning to speak as they would outside of your office can support them bringing their shields down to fully participate. You may want to make sure they understand all ways of speaking are permitted as long as they are respectful to both themselves and you in the room. In response, many teens will express relief in being able to be themselves.

By encouraging teens to speak in ways that feel right to them, you should also be prepared to be honest and open about slang or colloquialisms that you may not have heard before. This demonstration of vulnerability by the therapist can actually support the client in feeling empowered and serve as evening the status quo between therapist and client in the therapeutic relationship. This vulnerability also allows humor, another great tool with teens.

Media Influence

One final tool that can increase your success in engaging teens in therapy is remaining aware of the events of their world. Many teens are following popular social media stories, YouTube videos, celebrities, and TV shows that can serve as connections or analogies for concepts you want to explore in therapy. For example, a teen who is reporting difficulty making friends may resonate with the main character from The Edge of Seventeen, a movie that can speak to your teen in identifying similar stressors they could report they are experiencing. By remaining aware of pop culture references, you can engage a teen in comparisons that truly resonate with them, encouraging self-awareness and personal growth.

Tips from Teens

In review, there are many elements to keep in mind when engaging teenagers in therapy. A panel of urban teenagers here in Denver, Colorado provided meaningful feedback on how best to engage them in structured therapy. Their answers were both obvious and reassuring and I am happy to pass them on in the hopes that fellow therapists will find success in engaging teens in their therapeutic work!

Teenagers shared with professionals:

• Don’t talk down to us
• Don’t censor us
• Don’t be so much older that we can’t connect with you
• Don’t read our file and think you know us
• Don’t say you understand what we are going through when it’s our own experience
• Don’t label us
• Don’t tell our secrets to others
• Don’t be afraid of our tests to see if you are trustworthy
• Don’t give up on us

“Some are young people who don't know who they are, what they can be or even want to be. They are afraid, but they don't know of what. They are angry, but they don't know at whom. They are rejected and they don't know why. All they want is to be somebody.” 
― Thomas S. Monson, Pathways To Perfection: Discourses Of Thomas S. Monson

Mandated Clients: Motivating Change

“I don’t want to be here. I’m not going to say anything. I don’t know. Why should I talk to you?” A court mandated client sits in your office, required to participate in therapy as part of their treatment plan. You feel on edge, frustrated at their lack of engagement, maybe even resentful of the mental and emotional blocks that prevent rapport and valuable change. For those of us who might feel this gap between clients and ourselves, we know it becomes that much more difficult to connect, to hold space, and to offer unconditional positive regard, the building blocks that support the most change in fostering a positive therapeutic relationship. Considering the client’s circumstance, trauma experience, strengths, and resiliency can all serve as possible gateways for change and connection. With these aspects in mind, you may just bridge the gap or begin to gently chip away at the wall of resistance in support of a client’s healing journey.

Building Perspective

The client may come from a different background or hold different values, however, they still feel pain and suffering just as we can. Remember that crisis such as homelessness, financial instability and a lack support could prevent progress due to basic needs requiring attention first. Having realistic expectations of what a client can accomplish both short and long term can set them up for success in your work together. If their trauma revolves around trust or mistrust, being aware of how therapy and/or relationships have helped or hindered them in the past can put their current resistance in perspective. A few questions that you may find helpful at the first meeting to ask a client around this concept include:

• Have you had therapy before? What was it like?
• What did you like about therapy before? Dislike about it?
• How would I know if I’ve offended you in some way? How would your body, face, or voice change to let me know what something isn’t quite right?
• How could I help you feel comfortable enough to tell me if I’ve done or said something that prevents you from talking with me freely?

All of these questions encourage your client to have a voice in the therapeutic process and can demonstrate their level of self-awareness as well as self-advocacy in the room.

Practicing Presence

Understanding a mandated client’s need for trust as well as acknowledging the power of consistency and ‘showing up’ can all have significant impact on the experience of therapy for a mandated client. For many clients, having someone invested in them and honoring their needs for safety is noticeably different from the relationships they’ve experienced in the past. Even when you feel that you aren’t making significant progress on a treatment plan, holding space for a client and developing a healthy therapeutic relationship can be more significant than we realize. Similar to group therapy where we witness the group as a social microcosm or opportunity to explore interpersonal skills repeated in varying interactions outside of group, the therapeutic relationship can help us identify relationship strengths and challenges that are seen in other spheres of the client’s life for possible change and improvement. Remaining present with a client in their experience through supportive feedback, empathy, and empowerment can encourage the desired change in ways that feel safe.

Check Yourself

Supporting safety by asking questions of client regarding their experience in your office can be very helpful, however being aware of your own assumptions, biases, and language can be equally important in working with mandated clients. Could your language choice be isolating rather than empowering? Are you approaching their needs from a strengths perspective, understanding that their behavior could reflect survival, a pattern of attempting to meet their own needs in any way possible?

Consider the following as possible gauges for yourself:

• Reading their entire case file and developing a plan based on that information versus speaking with them about what they want to work on.
• Seeing their choices as immoral behavior that requires fixing versus reframing behavior through the lens of survival and in response to trauma
• Using words that are possibly offensive to your client such as criminal, paranoid, or bipolar versus language reflecting their personal experience with legal charges, bipolar disorder, or caution with others in response to safety needs.
• Noticing your ability to interact and identify strengths of a client to maintain unconditional positive regard

Increasing By-in

Once you’ve explored your own presentation and values in the room with a mandated client to allow them to feel safe, you will continue to gauge what will support them in their process. For many clients, acknowledging they aren’t in therapy of their own free will can be the start of a conversation of what they’d like to get out of sessions in having to be in attendance. Asking questions like, “What would make this worth your while? What would you like to get out of this in having to be here?” can be supportive in normalizing their resistance and empowering them to be part of the process. If you receive a response of, “I don’t know,” don’t lose heart. Many clients need to witness your commitment to their process by being patient and present with them each week. Some clients will even test your limits to see if you can respond to them in ways that feel safe enough to encourage them to open up and trust. In considering all of the tips above, you will feel more prepared to meet resistance and offer an environment that feel supportive for clients to engage and grow.