1. Trying to motivate the teenager to change

Sometimes we’re the only one of two people in the room who care about what happens. This, in itself, is enough to make us work twice as hard. That’s a problem.

Many therapists believe you need motivated client in order for therapy to work. I don’t. I think you just have to be interesting enough for the client to become intrigued about what you might have to say or about what might happen in therapy with you. You want their interest in the “possibility” of something good or useful happening. Their desire to come back another time is all the “motivation” you need.  Trying to convince a teenager that therapy will be good for him is going to sound like a sales pitch and the kid’s gonna run.

Clients change because they allow us to influence their way of thinking about something, or about doing things, or about responding and relating to others. We don’t need their motivation. We need their interest, so that we can get an “at bat.” Think about the clients you’ve been able to help. Was it their motivation that did it (something over which we have little control), or was it their degree of engagement with you and your work (something over which we do have control)? Dont worry about getting your clients motivated; instead, think about how to get their attention. If you get their attention, and they think you can help, they be plenty motivated enough.


2. Appealing to logic or a teen’s more “rational” manner of behaving  

One of the best things we can do as clinicians is to distinguish ourselves from the scores of parents, relatives, school counselors, and teachers who are hoping to get teenagers in trouble to see the fallacy of their thinking in favor of a more reasoned and logical choice.

Here’s an example of a therapist imploring her client to think more “rationally” by suggesting she look at herself from the perspective from which she saw others. It drew not the “Oh yeah, I guess that’s true” the therapist had expected, but rather a dismissive shrug and change of topic.

“I feel responsible for everything,” said Gemma, when asked by her guidance counselor about the stressors she experienced at school. “If I’m involved in a group project, and we get a bad grade, I feel that it’s my fault.

“What would you think if a friend told you that same thing — that she felt totally responsible for the other students in a group project that she was part of? Would you hold her responsible?”

Of course not. But thats different,” Gemma replied, and indeed it is. There’s Gemmas friend, and then there’s Gemma. People have different rules for themselves than they do for their friends. For that reason, this is not a very helpful intervention.

The temptation for therapists to push back against a client’s (seemingly unreasonable) idea is often strong. You want to say, “C’mon, really? What makes you the fall guy?” But therapists are rarely that forthright. Painting broadly here, I’ll say that instead, many therapists soft pedal their point, so that it comes out as a more tentative proposal: “Well, what if it were a friend of yours that …?”

I believe there’s something about the frankness and candor of the first comment (Cmon, really?…) that cuts through a person’s stylized/default defense and invites them to respond in kind: “Oh I don’t know, I just worry about getting a bad grade…” or “It’s just easier that way …” or “I don’t want anyone to think I’m just leeching off of them…” which at least gives you a little more to work with than Of course not. But thats different.

All that said, there is a big difference between asking a client if she would feel differently if what was happening to her was happening to a friend, and inviting your client to see things from another person’s point of view. In the latter, you’re inviting someone to suspend judgment on something — an event, a belief, a behavior — that, let’s say in this case, is outside the dyad of Gemma and her friend. And while Gemma has rules for how she handles her friendships, for example: I always treat my friends better than I treat myself, or, I never want to do anything that makes my friends mad at me, Gemma is unlikely to have rules for other events or people with whom she does not have a relationship. That’s why Gemma could more productively answer a hypothetical question about other people than one about herself or people she knows.


 3. Overlooking breaches in common decency for the sake of keeping a false peace

Few things cuts into a therapist’s credibility with young clients faster than the reluctance of that therapist to stand behind what both parties know to be true — e.g., that this particular teenager could, in fact, have “helped it,” that he did, in fact, “know better,” and that he totally understood that once he did A, then the world around him could only respond with B. Moreover, in contrast to the assumption that asking teens to be accountable for their choices risks fracturing the therapeutic alliance, I believe it’s more likely to be the very thing that cements it.

Teenagers respect those who own and will say what they believe, especially when tempered by graciousness and free from judgment, blaming, directives or prescriptions. This unsolicited respect becomes an important vehicle through which young clients will allow themselves to be influenced, guided, coached, known. These kids have a lot of adults in their lives who get in their faces and try to muscle their points across the divide. They also have a lot of adults in their lives who over-accommodate their poor behavior. What these kids don’t have enough of are adults who have their back and at the same time can help them see through their own b.s., and who can talk with them about their problems without raising their defenses or having them bolt prematurely from conversations.