Welcome to the July edition of Tips and Topics.
In SAVVY, adolescent developmental issues challenge both parents and their children. If an adolescent client shows up for an appointment, frame it in your mind and theirs that they are very motivated for treatment. How social media complicates developmental issues for adolescents.
In SKILLS, don’t put adult expectations and values onto adolescents when it comes to communication and engagement in treatment. What is most important to the client should be the goal of treatment, not what you think they should be working on. This allows for accountability and outcomes monitoring. Discussions about social media.
In SOUL, I am always interested when I see clips of accomplished people reflecting on “What would I tell my younger self?” So I thought I’d give it a try too. I share my top three things I wished I had known when I was younger. But that would be “young wisdom,” an oxymoron.
Last month, Delilah Mahl, a graduate student at Hazelden Betty Ford Graduate School, interviewed me for a school project on adolescent treatment. Here are some SAVVY and SKILLS Tips we discussed. If you’d like to watch the whole 40 minute interview, you can get more of the context of the following tips.
Tip 1
Developmental stages of adolescence present challenges for both the youth and the parent.
Separation-Individuation is a normal process in the journey from child to adult. As young people strive to form their own unique identity distinct from the family culture and parental expectations, the adjustments go both ways:
Adolescents seek to find out how they think, feel and want to act.
Parents and caregivers confront how to think, feel and act towards their ever-developing and separating child.
Both youth and parents face the challenges of:
(a) Dependence – independence: The adolescent wants to be their own person and yet is dependent on parents and caregivers for food, shelter, transportation, and clothing. Parents want their child to become increasingly self-sufficient and prepare to be self-supporting, yet are not sure how to nurture healthy independence.
(b) Autonomy – control: Youth want to be free of nagging and being told how to think, feel and behave, and healthy parenting wants to encourage such autonomy. Yet if their child behaves in ways that parents don’t approve of, the impulse is to control what the child thinks, feels or does.
(c) Letting go – keeping close: Youth want independence and autonomy, yet can be ambivalent as they face uncertainty about who they are and want to be and how to be self-sufficient. Parents are similarly ambivalent as they want their child to fly free from the family nest but face impending “empty nest syndrome.”
Tip 2
If an adolescent client shows up for an appointment, frame it in your mind and theirs that they are very motivated for treatment.
More often than not, youth are brought to treatment by a parent or caregiver focused on dropping off the problem child for you to fix. Very few adolescent clients wake up one day and spontaneously declare, “This is the day to seek treatment.”
So when an adolescent shows up for that first appointment, how can you frame it as working with a very motivated client? Think of it in reverse. If they did not want to go to the appointment, how easy would it be to force them to go? Have you ever tried to nag, yell, cry or physically move them to do anything? How is that working for you?
If a youth gets into the car, the waiting room and then the office, they are very motivated for something. That “something” may be to:
Get the parent off their back and to leave them alone
Get their phone back or some other privilege that was withheld
Get off a one month grounding
Or for some, happily, to actually want therapy work to feel better.
Whether it is to avoid some negative consequence or to actually find relief from internal pain, they are very motivated. The outcome and goal of treatment may then be:
Let’s see how we can work together to get them off your back.
Would you be willing to explore with me how to get your phone back?
I’m willing to work on helping you get off grounding if that’s what you want.
I’m sure we can work together to help you feel better.
Tip 3
The speed and reach of social media complicate developmental issues for adolescents.
Social media has profound impacts on adolescent developmental tasks like:
Identity formation
Peer selection and approval
Self esteem, self love and expression
Youth today have such rapid access to role models (for good and bad) on a global stage. As they sift and sort through the images, stories and flood of today’s news cycles and social media posts and reels, who they are and how they want to be can be overwhelming.
Finding their peer group and seeking peer approval is so fraught with the instant feedback social media provides:
Post a reel on Instagram or TikTok and it is tempting to measure your worth by the number of “likes” you get (or don’t get), not to mention the comments that can be reinforcing or devastating.
Notice what posts and stories get millions of views or “go viral.” It is easy to believe you have to be over-sexualized or do something outrageous to get attention. Or, for good, notice that musical talents, uplifting creativity and random acts of kindness can also get millions of views and likes.
How does a young person navigate through the bombardment of rapid inputs to reflect on developing their identity, peer group and self-esteem?
Adolescents have an uncanny way of pushing your buttons as parents and/or clinicians if you have not fully embraced your own childhood woundings. So here are some Tips to help stay person-centered in adolescent treatment.
Tip 1
Don’t put adult expectations and values onto adolescents when it comes to communication and engagement in treatment.
Have you ever had conversations with a youth that sound like this?
How was school today?
Fine.
How can I help you today?
I don’t know.
What’s going on right now?
Nothing.
Even adults can have trouble knowing what they are feeling and how to articulate that. For youth, it can be all the more challenging to identify their inner feelings and express what is going on in the moment.
One of my adolescent psychiatrist supervisors taught me the following method to help adolescent clients identify inner feelings:
Rather than talk directly about the client in the room, he suggested you share observations about other similar aged youth he had worked with – “There are some clients I’ve worked with who felt it was their fault when their parents divorced and they got quite depressed and self-blaming.”
“Some young people your age find themselves unsure about how to handle anger or hurt feelings or feel like they don’t belong.”
Test out educated guesses about what might be going on with your client and observe for any resonance, identification or opening up from your adolescent client.
Tip 2
”Thank you for coming today. What’s the most important thing you want that made you come today?”
Motivation to avoid a negative consequence (stop the nagging or get my phone back) is just as clear and legitimate a treatment goal as “I want to feel better from my depression.” What is most important to the client should be the goal of treatment, not what you think they should be working on. This allows for accountability and outcomes monitoring.
Whatever the goal of treatment, involve the adolescent as well as the parent(s) or caregiver(s) at every session to get real-time data on whether everyone is getting what they want. For example:
Adolescent’s goal: Get my parents off my back. Parents’ goal: Get him to behave.
At each session, see the adolescent first to see how often his parents were nagging him this week and what he was doing that provoked the nagging; or what worked if the nagging was less.
Usher the client out to the waiting room and bring in the parents. How was the behavior this week and what did you do if it didn’t go well; or what worked if it did go well?
Bring them together to compare notes on what happened this week from each other’s perspective. The therapy work is for the adolescent to identify what produces more nagging or less; and for the parents, what works or doesn’t work to improve their adolescent’s behavior.
Tip 3
Engage young people in discussions about social media to assess and influence their emerging values.
Here are some suggestions on how to engage youth constructively around social media:
Plan a family meeting so each family member can share a post or reel that inspired them, e.g., a talented 10 year old musician or singer; or amused them e.g., cute animal antics or a comedy clip; or a thought-provoking post, e.g., screenshots on “How to have a repair conversation after you’ve hurt each other” or a 60-second clip on how to deal with a narcissist.
To assess and shape the values of the adolescent, notice not only the positive pieces of social media, but see how they respond to “Now let’s share something that disturbed, frightened, or appalled you.”
Role model a healthy relationship to screens, assuming you have a healthy balance of face-to-face socialization with friends; time with reading books or hobbies; exercising and physical activity.
Social media isn’t going away. Just as we teach youth how to drive safely and use a potentially deadly machine, we have the same opportunity to use social media safely instead of a deadly head-on collision.
I am always interested when I see clips of accomplished people reflecting on “What would I tell my younger self?” So I thought I’d give it a try too. Here are my top three:
1. Worry less. If you are anything like me, it is a tall order to just sing, “Don’t worry, be happy.” I don’t know if it is scientific fact, but I saw somewhere that 85% of things we worry about never happen. Here’s a quote that speaks to me now: “Worrying is using your imagination to create something you don’t want.” - Abraham Hicks.
2. What you focus on you will get more of. Pay attention to what you fill your mind with and spend the most time focusing on. Before I understood the Law of Attraction, I didn’t realize that it is just like the Law of Gravity. Even if you don’t believe in it, it still works. Focus on the reasons to despise the other side and you will attract even more reasons to reinforce your view. Focus on the goodness of people and you will find even more of them.
3. The only relationship you will have until you die is with yourself. Make peace with yourself; love yourself so you can love your neighbor as yourself; and be gentle and compassionate with yourself just as you would to a friend who might be struggling with something. Don’t be quick to fix problems by changing a partner, a job or where you live. Check inside to see if there is personal healing to be done. Otherwise you will just take yourself into the new relationship, job or location and nothing will change.
Ah, if only I had known all this when I was younger… young wisdom. There may be some youth with “old souls” who have wisdom at a young age, but for most of us that would be an oxymoron (a figure of speech that pairs two contradictory or opposing words together).
What would you tell your younger self?
Thank you for joining us this month. See you in August.
David