Oh, Let Me Count the Ways…


1. Many of the teenagers we see have not asked to be in therapy (although that is changing in the wake of the youth mental health movement). They were brought by parents or other caregivers or sent there by their school or the courts making the therapy, at least in the beginning, non-consensual. This changes almost everything about it, drawing into play issues of power, respect, and implicit communication that profoundly affect the relationship between therapist and teen, as well as the course and outcome of therapy. Did your graduate/training program pay a lot of attention to this? Mine didn’t; I learned on the fly.

2. As a result, the relationship dynamic is different with teenagers than it is with adults. Teens are experts at discerning adults’ vulnerabilities and anxieties and, if they choose, will exploit them like no one’s business. All those things we hope to be in session — helpful, trustworthy, competent, credible — are exactly what we might feel stripped of. For example, those therapists to whom it’s important to appear in control of the session will find themselves struggling to keep any semblance of that. Those who try to hide their anxiety about not knowing what to say are rendered speechless in no time flat. And those who try to meet all the wishes of the teenager in an attempt to establish a rapport find that the conditions they’ve agreed to simply wind up compromising the integrity of the therapy to begin with.

3. Therapists working with teenagers need to be able to maintain an even perspective in the face of extraordinary stories, affects, and dynamics, all while responding authentically and emotionally and at the same time demonstrating thoughtfulness and self-restraint. This is difficult, and some clinicians are better suited for it than others.

4. Working with teenagers requires a unique set of communication skills, such as a fluency in nonverbal communication and a personal comfort with mosaic, rather than linear, communication patterns. Again, not all therapists are comfortable with this type of “language.”

5. Therapists working with teens need a working knowledge of the social culture in which these kids are growing up. It’s less about knowing the current music or fashion scene than it is about knowing what it’s like to be a teenager in these times, with the pressures that lead to almost paralyzing levels of anxiety for some and despairingly low moods for others. And please don’t ever say that you were a teenager once too. It really is a whole different world. So much has changed in the past decade plus, and it’s changed in ways that have altered the DNA of how kids communicate with one another, stay connected or don’t, relate with family members, acquire information about the world, and plan for their futures, among many other things.

There are others, too many to mention, but you can read about them in my forthcoming book, “Therapeutic Conversations with Adolescents: Helping Teens in Therapy Thrive in an Ultra-Competitive, Screen-Saturated World” which comes out later this year.


— Janet Sasson Edgette