1. ”Insight is important for change.”

Not really. In fact, I think that a lot of the tasks associated with acquiring insight distract from the more immediate task of therapy, that is, getting kids to feel better or do things differently, or to think about things or themselves or others differently. The language of traditional, insight-oriented therapy is foreign to kids; it’s not how they will move through and past their problems.

2. “Rapport is king.”

Again, not necessarily. In the spirit of establishing rapport with adolescent clients, many therapists set the scale too heavily in favor of empathy and support over issues of accountability. The teen doesn’t connect because he’s not being offered a “real” relationship, just a “nice” one. Moreover, rapport doesn’t need time to develop; it needs traction, and traction comes from engagement and respect, which comes from a therapist’s credibility and authenticity.

3. “Talking about feelings is important.”

Oh so not true. The great effort that many therapists make to get teenagers to talk about their feelings is one of the bigger reasons why their therapies derail. We all are so much more than a compilation of our feelings, and the partisan emphasis on expressing one’s feelings minimizes the colorful, complex tapestry of our identity, psyche, and soul.

At the very least, if you’re going to ask about feelings try doing it in a more oblique manner that doesn’t isolate them from a larger and more meaningful or interesting context, for example:

  • What do you hear on the news that makes you want to jump out of your seat and do something?
  •  What do you hear about these days that makes you cry? Want to run and and hide? Want to hug someone?
  • Oh my god, I can’t even imagine how crazy excited I’d have been to have the opportunity to meet the band backstage. What was it like?

Besides, what kid doesn’t roll her eyes when hearing that tired phrase, “How did that make you feel?” We need to bury that one.


4. “Therapy should be experienced primarily as a ‘safe’ place.”

Therapy should be safe in all the right ways: no judgment, no snark or sarcasm, no “making a point” in order to feel you’re “doing something,” no provocation or criticism because you’re feeling frustrated or annoyed with the client. But it shouldn’t mean that clients won’t be challenged, or that they shouldn’t have to account for their choices when they choose to be mean or manipulative or disrespectful or irresponsible.

Accountability makes some clients feel defensive, disillusioned, or vulnerable — unsafe. But done sensitively and artfully, your endeavor to hold clients accountable for some of their indecorous decisions becomes an indispensable part of the therapy: Wow, you said that to her as casually as if you were telling her what you just had for breakfast. What is so very easy for you to say would be hard for most. How were you hoping she’d respond?

The role of accountability in adolescent therapy is never a matter of getting a teenager to “own up” to problems or agree to work on them. The therapist is simply ascribing intention behind the client’s actions or choice. Accountability is valuable for its ability to dis-illusion the teen, that is, to reinforce the idea (without confrontation) that one cannot necessarily control the (public) narrative surrounding one’s actions. It’s a way for therapists to not have to go along with something objectionable, while also not feeling any pressure to directly criticize their client at that time.

One needs to always be kind in their work with clients — no matter the age. But therapies that are all about being “safe” wind up being therapies that are all about being “nice,” in which case we’re not even talking about therapy anymore.


— Janet Sasson Edgette