Adolescence is a time of rapid and multiple changes for the teenager and the family. In some ways the teenager is making a move toward adulthood with increased desire for independence and increased capacity for responsible behavior. On the other hand there are ways the teenager is still a child requiring guidance and protection from adult caretakers. While it is expected that teenagers and their families will struggle to find balance between independence and dependence, sometimes the balance can be lost. Some teenagers act as if they are afraid to grow up, others as if they are trying to grow up too fast, and still others can shift back and forth between the two extremes.
The triggers and/or risks for difficulties during adolescence can include:
- Exposure to interpersonal trauma (see also childhood trauma section) or severe interpersonal distress such as exposure to bullying
- Chronic marital conflict, separation, divorce, and/or remarriage
- When puberty occurs well ahead or well behind one’s peers or well ahead of the child’s psychological readiness
- Development of sexual orientation and sexual & gender identity including Lesbian, Gay, Bisexual, Transgender (LGBT) issues
- Exposure to racism/discrimination
- History of parent-child relationship difficulties
- History of mental health and/or academic difficulties
- Parental/family distress – can include economic distress, parental mental health problems such as depression and substance abuse, death of a family member, and/or other such difficulties
Signs that your teenager might need or benefit from psychotherapy:
- Chronic withdrawn and isolated behavior
- Chronic and extreme moodiness
- Alienation from family members particularly parents
- Child-like behavior – preference for activities enjoyed when younger, preference for interaction with younger children, anxiety about being alone, excessive need for reassurance
- Social anxiety, low self-esteem and avoidance of challenges, other forms of anxiety
- Academic difficulties particularly significant drops in academic performance
- Chronic aggressive behavior – physical fights, bullying, verbal insults and threats, vandalism, behavior that leads to chronic difficulties with authority figures including breaking the law
- Conflicts with peers and/or difficulty sustaining peer relationships
- High risk & self-destructive behavior including substance/alcohol abuse, unprotected sex including sex with an older and/or exploitative individual, cutting or other self-harm behaviors, suicidal threats or gestures
How I work with adolescent patients:
- Psychotherapy relationship
• Provision of safe/private space for the adolescent to get to know him or herself
• Provision of a balance between support and acceptance and challenging your teen to grow
• Modeling thoughtful self-reflection, honesty, respect for self and others, and social skills
- Focus upon developmental issues – specific focus depends upon age and maturity of the adolescent
• Identity/self-esteem – identify & develop talents/skills, personal qualities, values system, and budding future vision of self; grapple with personal limitations, recovering from failures, and sustaining motivation when things get tough
• Sexual identity development – helping teenagers to find the words to describe the experience of changes in body and self-image, sexual feelings, sexual boundaries, and budding sexual orientation; defining what feels good, bad, and scary within interactions with peers and adults; developing skills to communicate successfully with peers and adults about sexual issues, to set boundaries, and to seek help when needed; and developing a sexual value system where the teenager can begin to feel confident as a sexual being, know what he/she is ready and not ready to experience, and begin to integrate sexuality, romance, emotional commitment, and respect for self and others.
• Balance dependence and independence
• Skills to support emotional regulation, social skill development, decision making, sustaining motivation, responsible behavior, relationship capacity, and self-care
- Parental guidance with a focus upon improving parent-child relationships, helping parents understand and respond to adolescent developmental issues, and helping parents find balance between encouraging independence and provision of structure/protection in accordance with your values and goals as parents
- Help parents to negotiate differences in parenting style and related goals/values
- Help parents and their adolescent access and successfully utilize community resources to support the adolescent’s development
Short-term interventions for teens and parents:
- We will work together to assess how the family was doing prior to the onset of the problems for which you are now seeking help. When the parents and teenager have a strong and stable relationship history and the teenager has typically performed well academically and enjoyed good peer relations prior to the recent onset of difficulties, short-term treatment can be beneficial.
- Examples of developmental issues for which short-term interventions can help include: (a) the coming out process for LGBT teenagers, (b) parent-child communication problems that began with the onset of puberty or during adolescence, (c) adjustment to new school, and (d) peer relationship problems that began with onset of puberty or during adolescence including issues with dating. There might be other issues not listed here that can be appropriate for short-term interventions. The initial assessment process will help us to make that determination.
- Short-term intervention strategies can include: (a) sessions with parents or with parents and the teenager to address communication problems; (b) sessions with the teenager to help name the problem in terms of thinking, feeling, and interacting patterns that are currently getting in the way of successful adjustment to developmental changes; (c) helping the teenager to name the developmental changes he/she is experiencing and finding ways to seek peer support and solidarity. To put it simply it is about helping the teenager to develop a sense of normalcy and belonging; and (d) providing specific strategies for stress management, self-reflection and self-expression, and social skills.
Limits of Practice – in cases of substance addiction, extreme antisocial behavior, high risk for suicidal behavior, and/or impaired capacity to participate in psychotherapy within a private practice setting I will assist the family to access appropriate resources and referral