Counseling Teens & Pre-Teens

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 Many parents come to a place where they think their son or daughter could benefit from some counseling, but they are unsure how to get them to come in.

Let me first say that therapy is most successful with people who want to be there. However, it is the rare teen that walks up to their parent and says, "Mom, Dad, I've noticed I haven't been myself lately. You don't know this, but I have been using methamphetamine and thinking about killing myself the past 2 months. I think I could use some counseling." 

Instead, parents see the behavioral signs - the yelling, mood swings, isolation, drop in grades, change in friends, etc. A balance must be struck between insisting your child attend therapy (as you would a doctor's appointment), and realizing that therapy will not be successful if the teen adamantly does not want to be there.

Just a note: If you have the rare blessing of a teen or pre-teen asking for counseling, please seek counseling. Teens who ask for counseling are often in a large amount of pain, and their efforts for getting help should be taken seriously. 

"We think you are crazy"

"We think there is something very very bad about you"

The first thing you've got to do is get past this assumption.  I've heard it over and over again with the teens I work with.  Regardless of what parents have said, this is what teens think deep down that the parents are really saying.  

So, just start by addressing this head-on.  "We don't think you're crazy or a super-bad kid.  But we don't want to ignore the pain that we think you are in, and we don't know how to help you."

 Tip 1:  No surprises
Early in my practice, I had a 14 year old girl come in with her mother. Her arms were crossed, her eyes were glaring, and she was giving one word answers. This was not unusual. When I asked her why she thought she was there in therapy, she said she didn't know, and that her mother had told her they were going shopping but instead they had come to therapy.

This is a set-up for failure both for the teen and for me (the counselor). How can she NOT be angry and defensive about therapy when she was lied to?   In situations like these, it is difficult to move past the initial anger and betrayal and move into a time of processing the reasons for attending therapy.

Tip 2:  Have a conversation before attending session
If you believe your teen may be open to attending therapy, speak to her about some of your concerns before coming to session. Explain why you think counseling may be a good idea. Some teens think therapy is a punishment. Some think they are attending therapy because you (the parent) think they are really crazy.

Here are some conversation starters:

"Jake, I am very upset about finding that you've been smoking cigarettes. I am worried because if you've been sneaking around smoking, it makes me wonder what else you've been doing. I am going to schedule a session with a counselor, and if she is a good match for you, I am hoping you guys can talk about what is going on."

Or:  "Sara, I have noticed that lately we have been fighting a lot.  And I realize that I don't really know how to stop arguing with you about your grades, because you used to get A's and now you get D's. I love you and I'm worried about you. I would like us to attend counseling so that we can work on this together. I'm not sure if it would be better for us to meet together or for you to meet alone with the counselor. But, I'm going to schedule and appointment, and we can all sort that out together."

Or:   "Amber, I have noticed that you just don't seem like yourself lately. You look sad, you've stopped attending choir, and you look like you've lost joy. Have you ever thought about talking with a counselor? I think it will help. I am going to schedule a session."

It is asking a lot of a teen or pre-teen to have them say that they want to attend therapy. If they are going along with minimal resistance, that is often their way of agreeing without losing face.

Tip 3:  Use the 4-session compromise
If you’ve followed Tip 2 and found your teen adamantly does not want to attend therapy, I recommend telling her that you want her to attend 4 sessions, and then you, she, and the counselor will discuss if more sessions are needed. Often, during the first session, the teen is so angry about being "forced" to attend therapy that the first session is spent understanding that anger. If the teen were to decide if she wanted to continue therapy at that time, she would likely say no, just to get back at mom or dad for having forced her to attend.

During the 2nd through 4th sessions, we are usually able to get past this initial anger, and begin discussing the pain. It is when the teen begins to discuss their pain that their reason for attending therapy becomes less about being "forced" to attend, and more about reducing their own pain.

Here are some conversation follow-ups for teens that are not open to therapy:

"Jake, no I don't think you're crazy. I think you're creative, wonderful, and stuck in a rut. The teen years can be really difficult, and I want us to go to counseling so that you can be all that you are, and not get bogged down by peer pressure, stress, or whatever is making you want to smoke. I want you to attend 4 sessions. After 4 sessions, you, me and the counselor will sit down and discuss if you need to keep coming. Would you prefer going on Thursday right after school or on a Monday evening?"

Or:   "Sara, I know you don't think you need counseling, but I do. Your well-being is important to me. Let's make a deal. If you genuinely try counseling for 4 sessions, and then hate it, (barring any safety concerns), I won't force you to keep going. But for the agreement to stick, you have to really try counseling. Do I have your word?"

Or:   "Amber, yeah, I know talking with a stranger about your problems sounds weird, but I think it's really important. I'd like you to try it for 4 sessions. If you don't like it after that, then we'll find a different counselor that might be a better match for you."

It may be appropriate to continue counseling after the 4 sessions, even if your teen is not open to continuing. We will assess and decide that together.

Tip 4:  Require attending therapy if there are safety concerns
There are exceptions to the 4 session recommendation. If there are safety concerns such as any type of suicidal ideation, substance use, self-mutilation, or if your teen is a danger to herself or others, then she is not in the position to decide if she wants to continue therapy or not. Until her safety concerns are resolved, she should attend therapy for her own safety.

Here are conversation starters for a teen with safety concerns:

"Stephanie, last night when we were fighting, you said you wish you were dead. I don't know if you were joking or if you were serious. I know you're going to say you were joking. But I care about you too much to take a chance, so I am scheduling an appointment with a counselor so we can sort this out together."

Or:  "Todd, when the cops brought you home and you were drunk, it really scared me. I don't know if it was a one time thing, or if you have an alcohol problem, but I love you and don't want to ignore something so serious. We are going to attend counseling. We can talk about why we're attending counseling, but just know that you are not talking me out of attending. We are meeting on Thursday after school."

Or:  "Emily, I read on your Facebook that you cut yourself sometimes. This really scares me. I want you to talk with a counselor because I love you and want to help you through this time."

Tip 5:  Remember you are not as evil as he says you are
Even if there are no safety concerns, some teens are going to rely on you insisting they attend therapy.   This goes back to teens needing to save face.  Even if you do everything “right,” your teen may still be mad at you for even suggesting he attend therapy.  As he is giving you the silent treatment, remember that you are helping him.  It is better to do something then to do nothing.

I meet with many older teens whose parents regret they waited so long to seek counseling.  Take for example 19 year old Jason (I’ve changed his name to protect his confidentiality).  When he was 12 his grades started to slip.  When he was 13 he started hanging around a different group of friends.  When he was 14 his parents think he started smoking pot but they couldn’t prove it so they didn’t do anything.  (They were wrong; he started when he was 10).  When he as 15 he was caught shop-lifting. When he was 16 he got a car and would continually break curfew and ditch school.  When he was 17, he got caught using methamphetamine.  When he was 19 he attempted suicide which is when his parents brought him to me.

Just imagine the heartache that could have been saved if Jason had entered counseling at 12 or 14.  The 19-year-old Jason’s therapy will likely be longer and more costly than the 12 year old Jason’s therapy.

Though it may be tricky getting your teen into therapy, and she may be mad you want her there, it has been my experience that most teens come to benefit and even enjoy counseling.