Recently I was interviewed for a study and the subject of adolescents and families in therapy was central to the interview. Also, I’ve been doing a lot of clinical training and the topic of the best ways to do family therapy, especially with adolescents, repeatedly comes up. It seems like a good time to share some of my thoughts about adolescents and their parents, in therapy.

When adolescents come into therapy for emotional issues and/or substance-abuse issues*, many times they’re being forced.  They don’t really want to be there, they don’t want to talk. If they’re using substances they don’t want to stop using and they’re often angry with the people that are sending them to therapy in the first place—most likely, their parents or guardians, but it could be also their school, probation, or family court.

They can show how angry they are in a variety of ways. They may give the therapist the “silent treatment,” they might express anger verbally or even physically, they might even, initially, increase risky behaviors.

One of the best ways to get pre-teens and teens to talk to and about their family relationships is to do family therapy as well as individual sessions. Adolescents who are uncomfortable or resentful or sullen in individual sessions might just appreciate the chance to voice their sadness, anger, frustration, etc., in family therapy. It is their chance to tell their parents what’s bothering them in a safe place. Remember, home may not be a safe place, either emotionally or physically or both.

It’s important for therapists and families to remember: the adolescent’s problems didn’t begin in a vacuum. Sure, interactions with peers can actually impact emotional health (and certainly make substance abuse a possibility), and there are other factors that can cause or trigger emotional problems or substance abuse. But generally speaking, difficult family dynamics are a big part of the problem. That’s why in many if not most cases, it is vital for the success of individual adolescent therapy to also do family therapy.

Those of you who’ve been reading Therapy Soup for awhile (or have read my book, Therapy Revolution), know that I believe very strongly in the use of goal-oriented, written treatment plans. I also believe strongly that both parents and adolescents need to understand very clearly what the treatment goals are.

Everyone involved in therapy also needs to be reminded that they will have to stay flexible because with such a complex situation (the more people in the therapy session, the more complex the dynamics), the treatment plan will usually need lots of modification.

I recommend to therapists that they should include in their written treatment plan specific interventions for the family. If you are reading this and are a parent or adolescent in therapy and are not involved in a treatment plan, ask your therapist to create one—right away! In most cases is better to have a treatment plan that will have to be revised than to have no treatment plan at all.

In individual therapy, the patient should get a copy of the treatment plan. In family therapy, each member of the family should get  a copy. (In some cases where there is high volatility, the other family members may actually have therapy sessions without the adolescent, in order to help them resolve the family issues). In any case, everyone should know what the treatment goals are and how they’re going to try and reach those goals.

Your therapist should also be taking copious notes in family therapy (he or she might ask to make a recording of the session so he can add to his notes, later). If the sessions are very rapid-fire, the therapist’s notes might have to be mental notes. After the session though, he or she must document every detail.

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.

Just like individual therapy, family therapy must be transparent. The family members need to understand thoroughly what the issues are and how they are going to work together with the therapist  and the adolescent to improve or correct them.

More thoughts on teens in therapy, coming soon.

*It is important to note that substance abuse issues are often very prevalent in teens recommended for therapy.