Teenagers are often coerced into treatment by their parents, the courts or school, so understandably they usually are unenthusiastic about the whole idea of treatment. Many teens believe themselves unable to explore their inner world and behaviors. Others feel that counseling is a waste of time.
Teens referred for family therapy, in particular, fear that the counseling will only bring them grief – their parents will become more demanding and their freedom will be restricted. It is developmentally normative for adolescents to seek more freedom, a sense of independence, and a voice in the decisions being made about their lives. The counselor must work to change a teen’s mind about the value of therapy, and help him realize that “there is something in this for me.”
Multidimensional Family Therapy (MDFT) is an evidence-based treatment for adolescent substance abuse and other behavioral problems. This treatment has been extremely successful in, among other things, engaging the teen in the therapeutic process.
What follows is how MDFT counselors earn the teen’s trust and build a foundation for behavioral change. These principles and interventions can easily be incorporated in other adolescent treatments.
Show Genuine Interest and Deep Understanding:
Communicate a sincere interest in the teen. Show respect and admiration about strengths. Treat the teen as an important person with fascinating experiences and views about life.
Give the teen an opportunity to express himself fully. Listen deeply. Try to understand what it is like to live in the teen’s life day in and day out – to see the world from his eyes. Try to answer these kinds of questions: What motivates her deep down? What are his thoughts and opinions that give him his character? What drives her to behave in certain ways? What are the things that his parents and others do to him that make him hurt and angry?
Understand his struggles and problems. Understand how and why she feels misunderstood. Understand what makes him angry. Communicate to the teen that you understand him – perhaps in a way he has not felt understood before.
Demonstrate Acceptance and Appreciation:
The counselor not only deeply understands the teen but also must communicate acceptance and appreciation despite the teen’s behavior and thoughts that society (and the counselor) might consider unacceptable. It is from this place of understanding, acceptance and appreciation that the teen will be willing to examine himself and make positive changes.
Judgment, a critical tone or “confrontational” attitude about the misbehaviors or poor decisions will immediately turn off teenagers.-Gayle Dakof
Judgment, a critical tone or “confrontational” attitude about the misbehaviors or poor decisions will immediately turn off teenagers. Teens are very sensitive to these kinds of attitudes and you cannot hide your judgment, no matter how seemingly subtle. Pay attention to your language and tone: Make sure you do not sound judgmental, blaming or disrespectful. You must find it in your heart and mind to truly understand, accept and appreciate the teen.
Remember as a counselor, you are creating a new relational experience for the adolescent, who is used to adults being critical, judgmental or just plain disinterested in their opinions and experiences. Nonjudgmental, accepting and interested behaviors stimulate a youth’s self-reflection, an openness to your suggestion and queries, and a process whereby the youth sees himself as a worthy individual who can have a happy and productive life.
Do Not Lecture or Instruct:
The counselor is there to help the teen understand himself better, believe in himself…-Gayle Dakof
Be assured teens will respond poorly when told how to feel and what to think. Clinically referred adolescents know already that that the counselor wants them to stop using drugs and alcohol, do better in school, not commit crimes, get along better with their parents: This is implied in the therapeutic relationship. It is unnecessary and unhelpful for the counselor to give a lecture about these things. It is critical that the teen understands that the counselor is not there to tell him what he is doing wrong, how his thinking is immature, what he should think and feel or how he should live his life. He has parents, teachers and probation officers who can do that.
The counselor is there to help the teen understand himself better, believe in himself, feel that he has the capacity to change how people treat him, and that he has a reason to change his behavior and begin making positive life changes.
A counselor might say:
Some people think they should tell counselors what counselors want to hear. You may think I want you to say that you don’t want to use drugs anymore, that you know they are bad for you, that you want to change your life. You know what I am talking about, right? So let me share my view on that. Please understand there is nothing that I want you to do or say. It’s your life, not mine. The only thing I want to do is to understand who you are and what you think, what you want, and to help you figure this stuff out. Then I can help you be happier, get more of what you want, have people treat you better. Does this make sense? So you don’t have to tell me things you think I might want to hear because there is nothing in particular that I want to hear. I don’t think that way.
Enhance a Sense of Agency and Control:
Through respectful one-on-one conversations, help the teen understand himself better – his fears, dreams, hopes, complaints. Help the teen realize that he has a critical role to play in determining what happens to him in the present and future; that he can influence how people, including his parents, treat him.
A counselor might say:
I think there is a lot you can do to make things better for yourself. You’re not giving up on yourself are you? Well I’m not. You have a side of the story to tell. Sometimes you say, “I don’t care.” How can that be so? I think you do care about how they treat you, about your life now and in the future. Everybody thinks you are a monster, right? And it makes you angry because it is not true. They don’t understand you. I want to help you get everybody—your parents, teachers, everybody—to understand you better. But you’ve got to help me. Do you understand what I am saying? Tell me what you think about what I’ve said.
You’ve got to talk to your parents about some of these things that we talked about. I can help you do that. Next, let’s have you set the agenda and let your parents know some of what is making you angry, how they hurt you and don’t understand you? Okay good.
As a genuine connection is established, you are in a stronger place to push, prod, instigate and challenge the teen’s thinking and actions. Help them think about their lives, friends, family, past, present and future in healthier and less self-destructive ways. Help them change their thinking; their understanding of themselves and their life; their feelings and ultimately their actions: how they interact with their parents and others, their substance use and engagement in criminal activities, school and work and friends.
A counselor might say:
I think we could do a lot here for you—to make things better for you. You see, I’m really interested in who you are in this family, and who you want to be, as your own person. What we do here is we work together to figure out how to make things better for you. I want to help you figure out what’s most important to you—the things that in your heart you know should change or that you want to change. We’ll work together—we will be a team. There is no reason why you cannot have dreams and goals, and make some of those things happen. I like talking to you. I see already that you are a really smart and thoughtful guy with a lot of strengths. Things can be better for you and I want to help you make that happen.
Solving the problems of non-engagement and drop-out from treatment is in the counselor’s hands. We must accept, and above all, understand the realities of working with youth. Beyond technique, it is the therapeutic relationship that underpins engagement and improves outcomes. From time to time, it is helpful for counselors to look in the mirror and ask themselves what they bring to each case—to each life they touch. A counselor’s internal response to this kind of self-reflection reveals attitudes and beliefs that will not be unnoticed by clients.
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