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.