You are working much too hard at the wrong job—your client's job — and not hard enough at yours— creating a setting and interpersonal climate so compelling that your client can't help but respond. Maybe I know why. We spend lots of time in graduate school and in post-graduate workshops learning how to connect with our reluctant, younger clients, but we don't learn how to make ourselves and our services interesting enough that clients will want to connect with us. In that first approach, we impose ourselves. In the second, we invite curiosity—a better backdrop for the therapeutic task of influencing another's perspective, behavior, self-image or conception of the world. |
Trying to get silent, sullen or uninterested teenagers to speak up in therapy is counterproductive. It only communicates that their participation is more important to you than it is to them. This is the first of several ways in which therapists lose credibility with reluctant clients. Another credibility loser, and one that frequently follows on the heels of the first, is the therapist's reluctance to speak directly and non-defensively about the difficulty he or she is encountering and the awkwardness associated with an adolescent's silence. The teenager whose therapist dances around this problem understands the therapist's tentative conversation-starting questions not as gentle prompts but as a reluctance to speak candidly about a mutually- apparent truth: It seems so hard for us to get any kind of conversation going. I'm not even sure you want us to. |
By avoiding the trap of feeling responsible for making something happen, you are free to discover how your young client's attitude or personality or perspective or manner of relating compromises his ability to get along in life. Cards and games and counterfeit conversations about the latest movies are no match for a clearly articulated observation that sharply but benevolently illuminates for the teenager some facet of himself that has not previously come to light. It can't be an interpretation (too academic), and it can't be a probing question about what the kid feels(too patronizing) and it can't be a call for reason (too pedantic). It needs to be a remark that points to some discrepancy between what the client thinks about himself and what others in his life notice about him. It is important that this observation come out of the therapist's experience of the person, and contain absolutely no demand that the teenager do anything about it. Free of any injunction to change, the indisputable (about the teen) becomes acceptable (to the teen). |
For example, a therapist is sitting with a l6 year-old truant who won't return to school of his own volition—not because he doesn't want to be there but because he's made such a big stink about what a waste of time school is for him that he can't go back without feeling as if he is eating crow. |
"You get so stuck on being right that you'll go down with your ship rather than say you've had a change of heart about something," the therapist says. "I actually think you'd rather be back in school, if only to ease your boredom, but can't tell anyone for fear they'd think you 'gave in.' What a corner you paint yourself in." |
Another therapist watches his teenage client dismiss his parents' concerns out of hand and asks, "Are you always so contemptuous of people's attempts to help you?" When the teen turns toward the therapist as if to ask, 'What was that about?', the therapist shrugs and looks earnestly at him, as if to say, 'What would you expect me to say, given what I see. Do you want me to placate you like the others do?' |
Some people ask how that kind of candor effects change in a recalcitrant client. I think sometimes that it is the only way a kid who never asked for our help can accept it when it comes. |
Of course, having the parents in the session with you and the teenager makes all of this a lot easier. You have a much greater range of therapeutic activity, and the teenager's decision whether to talk becomes quite unimportant. Just don't let the encounter become an individual therapy session with the parents in the room; orchestrate a family therapy session. Otherwise, you could wind up feeling as if you're having an empty conversation with a kid, while his parents watch and wonder how this is going to help him stop punching holes in walls or scouting the town for pot. |
Find out what the parents need to do differently in order to induce their adolescent child to make different choices. Find out what the parents need to know, or believe or do in order to engage their teenager's sense of responsibility for his actions. Find out how family members lost their ability to influence one another by talking, instead of yelling. Find out what the teenager might be trying to tell his parents, and why he can't say it in a way they can hear. |
Don't let the session become a hunt for the feelings underlying the worrisome behaviors or attitudes. Rather, highlight the way in which the teen makes his or her choices. Compassion is strongest and most genuine when the person to whom it is directed is simultaneously and publicly being held accountable for his choices. |
Sometimes, though, the parents are physically or emotionally unavailable, and it's just you and the kid. Ask him how he plans to handle the temptation of assuming you alone must make the therapy happen. Sometimes. it doesn't happen. Maybe the real therapy for that adolescent lies in learning to directly and appropriately decline a service that he feels is being foisted upon him. If the teenager's problems are out of hand and no parent is available to manage them, then it will likely fall on our other social systems to influence him. |
Conducting therapy with the reluctant adolescent client highlights beautifully the delicate states of tension and balance between accessibility, and reserve. The therapist must cultivate a partnership without ever letting it look as if she is giving chase. She must also help her client find face-saving ways to exit his problems, dignity intact. These kids often want to make changes that are in keeping with their parents' and teachers' wishes, but need a way to do so that doesn't feel like surrender and retreat. We can never forget that many of these kids don't come to this of their own accord, and cannot overtly ask for our help. |
Confronting them with their reluctance to do what they never agreed to do in the first place is yet another way in which this profession loses credibility in the eyes of this challenging consumer. Respecting both the teenager's ambivalent wish for help and her need to protect a burgeoning and brittle sense of autonomy affords a therapist a better platform for making a real connection that makes a real difference. |
