Let’s talk more about the importance of the therapist’s note-taking in family therapy with parents and adolescents (it is equally as important in individual therapy, for some related reasons). Without it, therapy is usually a wash. What I said in a recent post on parents and teens in therapy:

The therapist’s notes should be very detailed because many times people mis-hear, mis-communicate or mis-understand what is being said. If the therapist has detailed, accurate notes, the whole family has an opportunity to come together to review and discuss what really happened and this propels therapy along.

Having effective documentation is vital to the success of family therapy because there are oftentimes breakdowns in communication, especially when family members are hurt, scared, or angry.

The goal of doing therapy with parents and teens is in some sense to bring out serious issues in a safe place, a place where both the parents and the adolescent can feel they have the chance to be heard fairly.

Sometimes we get into what I call “holding patterns” when we try and articulate what’s going on with our family members. We say the same things over and over again, in slightly different ways, but we can’t seem to “land” and arrive at a solid understanding.

A therapist can actually mediate conversations between parents and kids and point out to the “other side” when a dead-end is reached. Also, a therapist can help re-frame thoughts and feelings so that they are spoken in a less potentially explosive way. Also, the therapist can bring all various feelings and thoughts together by restating them, so everyone can really listen and hear what is going on with the other person—maybe for the first time!

The only way the therapist can do this in a comprehensive fashion is by rigorous documentation of the sessions. Sure, a therapist can work with bits and pieces and help family members re-state their thoughts, re-frame their responses and find some common ground. But he or she will definitely miss out on at least some important “sound bites” or subtle, but pervasive assumptions that need to be addressed.

The communication breakdown generally stems from the denial system operating in the adolescent and the other family members. In a sense, the denial systems operate to maintain the status quo, to protect it, even if it is dysfunctional. In some cases this protection racket can be so extreme that even though parents want their child to improve, at some level they may be heavily vested in keeping things exactly the same—the symptomatic person in the family, in these types of cases the mentally ill or substance abusing adolescent can be the scapegoat, even the repository for all the family’s mishegas*.

If the teen is sick, then the parents (and often the rest of the family) can avoid dealing with their own stuff. They can blame the teen, they can focus on the teen, they can enable the teen. In fact, the depend on the teen for being, in an odd sort of way, the “anchor of their dysfunction.”

*Sometimes the overtly “sick” or “dysfunctional” adolescent, the one expressing symptoms, is the canary in the coal mine. He or she’s the one that is acting out the family sickness in the open while the rest of the family may be burying it deep. If the therapist can help family members parse their words, little by little entrenched family roles can be brought to light.

*A useful Yiddish word used in this case to mean “various dysfunctional behaviors and patterns.”

*It bears repeating: That’s a “sometimes” not an always.