You’d think that’s where a therapist would start, and maybe many do. I find it a task better suited to doing therapy with adults though, who typically are self-referred and have thought enough about therapy to actually have treatment goals. Moreover, most adults in therapy don’t feel as strong a need to save face as might a defensive teen, who is there only because someone said she should be, and for whom engaging in a conversation about treatment goals is akin to conceding that she does in fact belong in therapy: If I agree to work on a problem, they’ll think that I believe I have it.

We can never forget that many of our teen clients didn’t ask for help in the first place.  In some ways our engagement with them, at least in the beginning, will feel non-consensual. This alone changes the dynamic between therapist and teen, drawing into larger play issues of power, respect, and implicit communication, among others; ignoring its impact on their relationship can be very costly. In such cases, going about a discussion of treatment goals becomes a real non-starter. Is there anything on my face, lady, that says I’ve ever thought about a treatment goal?” our young client thinks. Therapists who press further end up looking as if they are steamrolling over their clients’ reticence in order to get on with the show. It’s a huge disconnect.

In my experience, talking about explicit goals isn’t going to get you the kind of animated dialogue that engages teenagers and illuminates the different dimensions of their personality. That’s how we find out what matters to them, what doesn’t matter but should, what keeps them up at night, why they don’t believe they can talk to their parents, the tragedies they’ve been through that no one in their family talks about — all of which informs our clinical thinking and helps us to identify the interventions to which each individual will best respond.

The therapy is in the conversation we have with our teen clients, not in the list of treatment objectives that may have little bearing on what they really worry about or suffer from. It’s in that conversation we find places to console, push back, re-direct attention, call for a higher level of personal accountability, normalize, or cultivate self-reflection and a greater awareness of the impact of their choices on the people around them, among so many other things.

People ask me, “If you’re not working towards specific goals, how are you able to make any progress?” There is progress because my clients and I are always moving in the direction of emotional health, even in the absence of specific objectives. Better emotional health and emotional intelligence mean better discernment, empathizing, perspective taking, boundary setting, articulating of one’s needs, loving. There are always situations requiring a very targeted approach— assessing risk and de-escalating heated conflict come quickly to mind—but I can think of few problems that wouldn’t be at least partly mitigated by enhancing the emotional sensibilities of our young clients. Besides, kids understand very well the reason for our meeting; there’s no need to make it that explicit. Pointing too fine a light on it can make even the most willing teenager balk.

I’ve always felt that one of our bigger challenges in adolescent therapy was in getting the teenager to forget that she hadn’t wanted to come, hadn’t wanted to talk. We do that whenever we offer a relationship and a conversation that matters enough to hold our young client’s attention and make her want to come back for more. It’s also how we get out of the conundrum of trying to get kids to talk with us. They talk with us because they want to and that, more than anything, changes everything.

— Janet Sasson Edgette