Therapy with Teens: More Than “Just Talking”

I would like to thank my friend, colleague, and co-author of It’s About To Get Real Unprofessional, Katelyn, for sharing her expertise with us today. The following is from a thread that she shared on her Twitter and gave me permission to post here.

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I hear a lot from parents that they felt past therapy experiences for their teens was “just talking” and they wanted the therapist to “do more.” And I’ve been trying to find the best way to explain why therapy with teens looks like “just talking,” but it’s SO much more than that!

Teens are so accustomed to being “taught” things—8 hours at school, club meetings, sports coaches, lectures from parents/adults, etc. They’re burned out from being talked “to” and it feels too much like normal life. Therapy needs to be different, it needs natural pacing.

Teens are also incredibly sensitive to inauthentic behavior. When adults are clearly trying to “muscle” a point across, they tend pull away: They want to be IN the discussion. When a therapist is trying hard to impart information like a teacher, they lose credibility to the teen.

As a therapist, the hardest part of my work with your teen is developing the rapport and the relationship to do great work. It’s a process that you can’t rush. But I know that, as a parent seeing your kid suffering, you just want to “fix it” as fast as you possibly can.

But sometimes parents make the mistake of projecting their anxieties onto the teen’s therapy process. They may even send messages to the teen that “therapy clearly isn’t doing anything if you’re still getting angry at me!” And this can be so damaging to their trust in the process.

And: Your teen might appear to get “worse” before getting better. Therapy is having them tune into their emotional life—and we live in a culture that encourages distraction and numbing. This is likely new and it’s hard for them to feel their feelings. It’s tough work but worth it.

Putting your teen into therapy requires an immense amount of trust in the therapist and we value & respect that. Putting that trust into a stranger is scary. It can put fear into the thought that your parenting will be assessed and criticized, or that “you” are the problem.

As a teen therapist, I always operate from the belief that parents are doing the best they can—and I’m approaching with openness and curiosity, not the intent to blame or critique. But building a relationship takes time and we only have one hour a week (usually) to do that.

What sounds like “just talking” is the therapist trying to immerse themselves in that teen’s internal world—their opinions on music, social media, news events, fashion, are all a part of understanding them and determining what will help them and resonate with them.

And the conversations get “real” meaning I’ll want their perspective on everything: Even if it’s brutal and harsh. I want to find out what they value, how they see things, what their goals are—even if they seem excessive or unrealistic. I want to listen first.

Skills work happens, but depending on the type of therapist, it can look different. I don’t put worksheets in front of teens because it’s not real, it’s not authentic—it’s a homework assignment. But I use evidence-based practice, those modalities are unfolding in our process.

We often laugh in therapy. That doesn’t mean it’s not hard work and that important discussions aren’t happening. Sometimes the best work is happening then. We laugh at the absurdities of anxious thoughts or our internal critics. We may watch a TikTok that resonated with them.

Along the way, seeds are being planted. We are collaborating on solutions. We are processing the connection between us. We are exploring values and goals. We are developing effective ways of meeting our needs and setting boundaries. It’s all happening.

I adore working with teens—it takes a lot of work to make the process look effortless. For parents, it may require patience when you’re desperate for things to change. We therapists honor that and are working as efficiently as we can, I promise.

Published by Dr Marschall

Dr. Amy Marschall received her Psy.D. from the University of Hartford in September 2015. Her clinical interests are varied and include child and adolescent therapy, TF-CBT, rural psychology, telemental health, sexual and domestic violence, psychological assessment, and mental illness prevention. Dr. Marschall presently works in the Child and Adolescent Therapy Clinic at Sioux Falls Psychological Services in Sioux Falls, South Dakota, where she provides individual and family therapy and psychological assessment to children, adolescents, and college students. She also facilitates an art therapy group for adolescents and college students with anxiety and depression. Dr. Amy Marschall is certified in Trauma-Focused Cognitive Behavioral Therapy and Telemental Health.

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