For Pros: Joining with Teens in Therapy

The other day I was going through some old grad school papers and I found the following short paper I wrote as a MFT student in 1996 when I didn't have very much experience working with adolescents. Looking back on it now 17 years later, even though I've certainly learned a lot since then as a specialist working with teens, I'm happy to say I was definitely on the right track.

Short Paper #4 Some Thoughts on the Importance of Joining with Adolescents as a Therapeutic Intervention

Jonathan Sherman Northern Illinois University FCNS 584--Dr. Linda Derscheid--December 2, 1996

I am quite comfortable around adolescents and generally connect very well with adolescents on many topics. However, the therapy setting is another story. I have limited experience working with adolescents in a therapeutic setting. This is the main reason I chose to do my internship with the DeKalb County Youth Services Bureau. The problem with therapy is that it automatically sets up a distinct hierarchy between the adolescent and myself that is foreign to me--they have to be there and by default I am part of the system that is making them be there. This sets up a relationship that is therapeutically unproductive. I have struggled with how to deal with this issue. In this paper I will address some of my thoughts on what I am finding that works best for me in my work with adolescents in the therapy setting.

I have found it helpful to stop trying to do therapy with adolescents who do not want to be in therapy. I realized that if I had to go to therapy when I was an adolescent I certainly would not have wanted to be there. Also, if some therapist thought he/she could get inside my head I would have been happy to show them how ineffective their methods would have been on me. How “cooperative” would you be if you were in their shoes. Given that, why would I expect any of the adolescents I am working with to feel any differently than I would have felt? So I stopped asking therapy related questions and just started talking with them. I have been telling them up front that I realize they have to be here in therapy and that it is likely the last place they want to be. I also realize that I can’t make them talk if they don’t want to and that I’m not going to try. I tell them that if they feel like telling me something then I would be happy to listen, but for now I don’t see why they would want to as they don’t know me and why would they trust me in the first place since they don’t even know who I am? I tell them I don’t feel it would be respectful to them to try to make them talk when they didn’t feel like talking or if I tried to make them tell me things they didn’t want to tell me. I further tell them that if their main goal is to get out of having to come to therapy, and out of the legal system, I can help them figure out the fastest way to get it all over and done with. “Get me working for you instead of me working for the system that is making you be here,” I tell them. This statement can help mobilize the adolescent to become more responsible for his/her own actions and life which Ambert (1995) points out as a key roadblock to overcome. This goal leaves the door open to approach therapeutic issues when able and keeps the therapy from becoming only a place to chat. When all that is laid out on the table and they know where I stand I have found that the adolescents I’ve been working with, who have histories of claming up in therapy, talk freely about what they like to do. It’s not “therapy” in the traditional sense, but they are talking to me, which to me is vital in our talk-oriented business. It is also more enjoyable for the adolescent who isn’t dreading the ultra-boring hour of therapy with some bozo who is constantly, and futilely, drilling him/her for information. So we chat about nothing in particular and I’ve been noticing that in the course of this “non-therapeutic” chatter these adolescents are telling me bits and pieces of information that are related to therapy.

Offer and Schonert-Reichl (1992) point out that one of the primary factors a adolescent considers when seeking help from another is the characteristics of that person. It is reasonable to assume that they are more likely to seek help from someone when they know they are understood and respected by that person. The key is respecting their world (and doing so genuinely and not as a technique). All the interventions in the world are useless until this base is first established. It is really unrealistic for therapists to expect most adolescents to want to cooperate in a therapeutic setting. When they are uncooperative they are labeled resistant. Often these kids are seen as resistant which seems to be a cop out for the therapist who is trying to bypass laying this essential foundation. I have yet to meet a 13-year-old who wants to spill his guts to some stranger who is trying to get him to say and/or do things he’s not the least bit interested in a place he doesn’t want to be. When I was 13-years-old I wouldn’t have. So I am learning to respect and honor the adolescents resistance recognizing that underneath it is anger, mistrust, fear, etc. I engage them with respect and stroke the resistance and validate that it is understandable that this adolescent wouldn’t trust me and I don’t expect him/her to for a good while. I want to get to know this person, their world, what they like. Does he/she like to draw? I will ask him/her to draw a picture of anything they like or a picture of how they feel about coming to see me or a picture of their family which will give me an opening and he/she can tell me about the drawing.. I like to work with adolescents using the “mirroring process” as a way to build rapport, safety, trust, and connection and adolescents usually like to be mirrored as this is something that they often do not receive. The mirroring process can be an effective way to connect with a adolescent. Adolescents really want to be listened to and be heard and understood where they are coming from, from their world. I believe if I can enter into the world of the other and look around briefly and gain an understanding and share this with adolescents, that this will build trust, safety and connection. As Butman and Arp (1990) point out, adolescents desire respect and support from adults. This is an important element of joining.

In conclusion, the process of joining is an intervention I have found useful in my work with adolescents in therapy. Through this joining process I have been able to assess strengths and problems and encourage verbal interaction with the adolescent that other means have not allowed me to do with them.

References

Ambert, A. M. (1995). A critical perspective on the research on parents and adolescents: Implications for research, intervention, and policy. In D. H. Demo and A. M. Ambert (Eds.), Parents and adolescents in changing families, (pp. 291-305). Minneapolis: National Council on Family Relations.

Butman, R. E., & Arp, J. H. (1990). Adolescent depression in its developmental and maturational context. Journal of Psychology and Christianity, 9, 34-43.

Offer, D., & Schonert-Reichl, K. A. (1992). Debunking the myths of adolescence: Findings from recent research. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 1003-1014.

Q&A for Pros: Looking for Work? Do a Networking Blitz!

Q: I have a friend just graduated with his masters in clinical psychology and is looking for a job (does not have his license yet). Do you know of any places that may be hiring?

A: Sorry, I'm not in the loop as far as any available jobs at this point. However, I would recommend doing a networking blitz:

1. Send a cover letter introducing himself with his resume to any/all of the treatment providers, mental health centers, rehabs, and agencies that interest him (and even the ones who don't, as you never know who will know someone who knows someone) and follow up the following week with a phone call. This may be an obvious suggestion, however, I'm always surprised by how many people don't.

When I was graduating in Illinois we knew we were moving back to Utah so Kara could resume her schooling. I only knew a few people in Utah professionally with whom to network. We had no money in reserve. I needed a job as soon as I got to Utah. So this was early Internet days so I looked up what I could online, but mostly scoured a Utah County phonebook I found at the library, for every single provider (solo, group, agency, etc) I could find and mailed them all the following networking letter with my resume.

May 1, 1997

Name Address Provo, UT 84604

Dear ________________,

I am currently exploring job opportunities in the Utah County and Salt Lake County areas. I am relocating myself and my family to Utah County where I am seeking employment as a mental health professional. I am looking forward to returning to the community where I had such rewarding experiences in the field. I am writing to you in the hope that you may be able to assist me in exploring employment opportunities with your organization or other organizations you are aware of that may have positions available.

I graduated from Brigham Young University in Family Sciences in 1993. Since then my training has been in the field of substance abuse with the Utah Alcoholism Foundation and in the field of marriage and family therapy at Northern Illinois University’s Marriage and Family Therapy graduate program.

I have enclosed my resume detailing my qualifications as well as my references. I will be available for an interview in your area after May 19th. Please feel free to call me if you have any further questions at (815) 756-xxxx prior to May 15th or at (801) 763-xxxx after May 18th. Any assistance you can grant will be greatly appreciated. I look forward to hearing from you. Thank you for your time and consideration.

Respectfully,

Jonathan D. Sherman

Enclosures: resume reference

I sent 70 of these. I then called most of them up. Nothing. However, that was the market then. But I did get one solid lead from the next method:

2. Contact the state division of his professional organization and see who there knows who's hiring. For my field it's the Utah Association for Marriage and Family Therapy. I'm sure he has one for clinical psychologists. This is how I got my first job out of grad school, which opened the door for every other opportunity I've had since.  I sent a modified version of my networking letter as follows:

May 2, 1997

Lynne Maynes, Ph.D. Counseling Center P.O. Box 681499 Park City, UT 84068-1499

Dear Dr. Maynes,

Beth Hughes with the UAMFT suggested I contact you. Last month I was able to talk with Becky at your organization and she suggested I send you my vita. I am currently exploring job opportunities in the Utah County and Salt Lake County areas. I am relocating myself and my family to Utah County where I am seeking employment as a mental health professional. I am looking forward to returning to the community where I had such rewarding experiences in the field. I am writing to you in the hope that you may be able to assist me in exploring employment opportunities with your organization or other organizations you are Daware of that may have positions available.

I graduated from Brigham Young University in Family Sciences in 1993. Since then my training has been in the field of substance abuse with the Utah Alcoholism Foundation and in the field of marriage and family therapy at Northern Illinois University’s Marriage and Family Therapy graduate program.

I have enclosed my resume detailing my qualifications as well as my references. I will be available for an interview in your area after May 19th. Please feel free to call me if you have any further questions at (815) 756-xxxx prior to May 15th or at (801) 763-xxxx after May 18th. Any assistance you can grant will be greatly appreciated. I look forward to hearing from you. Thank you for your time and consideration.

Respectfully,

Jonathan D. Sherman

Enclosures: resume references

3. And he's already doing #3--ask everyone you know who they know... And while I don't know of any leads specifically right now I'm happy to post the need on my Facebook and Twitter and see if anyone knows anything. It  may or may not yield anything, but you never know—and as of this writing POW! that's 4,700 people instantly added to his network! If there are any leads I'll forward them on to you, or your friend can friend me on Facebook and Twitter and keep an eye on these posts himself.

4. Consider the rural option. Question: Is he local, does he want to stay local or willing to relocate? There are often great jobs in rural settings/boonies and they are willing to pay more b/c a lot of people aren't willing to relocate and they desperately need providers. Further, many states have Rural Loan Repayment programs where by committing to work a min of 2 years in a rural setting he can get a lot and sometimes all of his grad school loans paid off.

Hope this helps.

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