Knowing how to get a teenager to talk in therapy is a skill that is easily learned, but rarely taught. Most often we approach working with teens the same way we would an adult, which can be problematic. Approaching a teen in therapy as if they were an adult, can increase resistance and disconnect if we don't understand or consider the nuanced world of therapy with teens. 

Activities to Build Rapport with Teenage Clients

When therapy gets off to the wrong start with a teenager, sessions can become tense, boring or strained. I find myself under more pressure to deliver activities or interventions that will heal the impasse, which creates more work for me. Ultimately, the teen and their parent can become unhappy with the results or impact of treatment and terminate therapy. Building rapport from the very start of treatment is essential but knowing the skills required to do this with teenagers is rarely taught in grad school. ,

Rapport Building with Teenage Clients Starts From The First Session

Building Rapport with teens starts from the very first session, which has to be different from the way we initiate treatment with an adult.  Unfortunately, we often start therapy with teens the same way we would with older clients, as we are trained to do so in school and training sites. A softer approach that focuses on the relationship over 'the problem' is needed. 

Building Rapport with Teenage Clients, Questions to Avoid

Most teens enter treatment as the Identified Patient, some are made to go by their parents, others by their school and some are court-mandated. Of course, there are many teens that initiate seeking treatment and to whom this might not apply. Avoiding questions that reinforce the idea that the teen is the Identified Patient is highly recommended. To start asking about their symptoms and the problems that bring them into treatment only reinforces the idea that the teen is 'the problem'. This results in a disconnect between you and your client. 

How To Get A Teenager To Talk In Therapy

Getting a teenager to talk in therapy is easy when you ask questions that are about the things they enjoy and are passionate about. These are 'Object Oriented' questions, as opposed to 'Self-Oriented' questions. Self-Oriented questions are aimed at the client's inner-world, and are the typical questions we ask adults. "How did that make you feel?", for example, is an inquiry into the feeling state of the person being asked. Object-Oriented questions are about things outside the client. Questions such as "How long have you had your dog" are about the client's dog, not the client's inner world. Object-Oriented questions are helpful to teens for two reasons:

1. Language - it helps teens engage with others using language, this seems to be an obvious statement, but clients who are less emotionally mature have a tendency to not communicate thoughts and feelings using words and use actions instead. 

2. Safety - Questions aimed toward the client's inner world can be perceived as threatening to pre-oedipal clients. While teens are technically not a pre-verbal level of organization, they still can still find these questions de-stabilizing. Object-Oriented questions are useful ways to strengthen the ego until the client feels safer. 

How To Do Therapy With Teens At The Beginning: Therapeutic Alliance

The counselor who is unaware of the developmental stage of their teenage client is not recognizing the struggle that has with engaging with the counselor and the therapeutic alliance.  At the beginning, therapy with teens is a matter of engaging the teen in conversations about things that excite them. Enquiring about friends, hobbies, pets and relevant pop-culture interests is easy and safe for most teens. 

Building Rapport with Teenage Clients: Questions To Ask

This course provides a breakdown of questions to ask teens in therapy that will help build the working alliance, without making the teen defensive or shut down. The course that My People Patterns offers on working with teens provides therapeutic interventions for teenagers in the form of our 'go-to' questions to ask in the first few sessions. Rapport building with teenage clients starts with a series of questions that build trust as well as an understanding of the client's inner world. 

Our Therapy Activities to Help Build Rapport

 This product has a full breakdown of questions to ask teens in therapy that will generate content as well as provide insight into the teen's inner world. 

Therapeutic Interventions For Teens: Therapy Activities.

My People Patterns has a range of therapy activities that will engage clients and build rapport.

Teenage Development - 

Adolescence is a period of turmoil in which several developmental milestones are met. One of the main stages of psychosocial development that teens have to move through according to Erikson is identity versus role confusion; in this period, adolescents are facing the existential task of determining who they are and how they want to live.

At this stage, teenagers often begin to individuate away from their parents and authoritative adult figures and create their own independent identities. As mature as they want to be, teens are still in the process of physiological development as their prefrontal cortex continues to grow until their early twenties. Teenagers may still struggle to control their executive functions such as regulating emotion or imagining consequences.  A therapist who works with adolescent clients may be wise to keep this developmental context in mind and appreciate how complex the feelings and stage of life is.

Between dealing with the changes going on in one’s own body and the social pressures put on adolescents by peers, family and culture, the teenage years can be challenging and confusing. Teenagers are in the developmental stage of constant transformation in multiple realms, physical changes, sexual development, cognitive growth as well as identity growth in terms of values and morals. On top of this, there is often a huge identity formation process that can get easily interrupted if the right care and support is not provided by adults. As a result, teens often require a balance between both structure and freedom and independence and dependence in therapy. A struggle against authority and a need for independence impact the therapeutic alliance if not handled well. This is made worse as communication skills in teens are still also being developed.  

The brain during adolescence is "particularly sensitive to its environment" (p.21) subsequently an understanding of the environment that a teenager grows up in is an important variable to understand, especially when attempting to understand the etiology of depression and issues with addiction (Davis, 2011). During this period, the teenage brain's increased sensitivity to external forces enables a deeper encryption of experiences within the neural networks, meaning that from a neurological perspective as well as emotional level, these years are incredibly impactful on our development. In object relations theory, early adolescence, from 12-15 is seen as being quite different from adolescence 'proper' which occurs after the age of fifteen (Schave & Schave, 1989). Schave and Schave (1989) go on to explain that the changes in structure and psyche in this earlier period of adolescent development are described by Piaget as being a dramatic shift in mental ability as the brain develops further. At the same time, a psychic softening occurs, that accompanies hormonal, social and educational changes. It is generally believed to be a very difficult time to traverse for an adolescent. If Blos (1967) is correct, and the adolescent years are indeed a second point of individuation, then affect attunement, mirroring and idealization are all important processes that the parent must continue to provide for the teenager. These important aspects of attachment behaviors are a behavioral system provides the child with a sense of security, to help them regulate affect, to help communication and express feelings and to serve as a base for exploration (Davis, 2011). Adolescence is characterized typically by a search for self and the need for a creation of one's own identity (Schave and Schave, 1989). One of the main concepts behind our sense of self is how we see ourselves in the relation to others, and more importantly, at the heart of each relationship is a sense of communication of thoughts and feelings. Affect, as this is known as, becomes then an incredibly important manager of our experience of self when in relationship to others. A child who is able to relate to his mother through effective attunement, is able to internalize her as an object that begins to lay down the foundation for the psyche and a sense of self. As childhood continues, interactions between parents and child go beyond providing physical needs of a growing child, and affect interaction becomes a pivotal part of identity and formation of a sense of self. This does not stop in adolescence; Davis (2011) says, "just as the impact of parents and caregivers on developing infants is critical to the development of the self, the impact of parents on early adolescents is equally important." 

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References

Blos, P. (1967). The second individuation process of adolescence. The Psychoanalytic study of the child, 22, 162–86.

Blum, A., & Pfetzing, V. (1997). Assaults to the Self: The Trauma of Growing Up Gay. Gender and Psychoanalysis, 2(4), 427-442.

Brodie, B. R. (2007). Adolescence and delinquency: An object relations theory approach.            Lanham, MD: Rowman & Littlefield.

Davies, D. (2011).  Child Development, Third Edition, A practitioners guide. NY: Guilford          Press.