I always thought the title of this sitcom was clever and I'm psyched that I can finally work it into something. With that out of the way, to the point.
One positive impact managed care companies have had on the field of therapy, particularly with teens is their push for family involvement. Despite this push and the enormous amount of literature and research supporting strong family involvement in adolescent work, I continue to come across therapists who view parents as an obstacle rather than a resource.
One factor driving this is the lack of training many folks charged with working with teens have in the area of family work. This lack of competence intimidates professionals to the point that parents may end up talking to the therapist, by themselves for a few minutes at the end of each session. These mini-sessions are seldom productive and give parents an illusion of involvement. It also keeps the therapist in his/her comfort zone while giving them a false sense of having equipped the family to make the changes necessary to help a youth towards positive change.
Another factor is the misguided belief that teens are capable of the kind of change that therapy incites in adults, and that parental involvement equates to a violation of therapeutic trust. This not only pathologizes the teen (usually unintentional), but ignores the reality that youth do not have the same mastery over their environment as adults do. They simply do not have the authority, financial resources or life experience to enact change in the same way. Many times therapists label teens as “unworkable” because little change occurs despite multiple interventions over an extended period of time. Yet they ignore the very system that, on one hand may trigger the teen and on the other may act as a catalyst for positive change if only that system were involved and informed.
Lastly, some therapists simply view themselves as expert of a teen's needs despite the fact that they only see them once a week for 45 minutes to an hour. Sometimes the assumption is made that if a teen needs therapy then the system charged with that teen's care must be faulty. This is either the result of poor logic, arrogance or both.
Adolescent work demands strong family involvement even if parenting skills are lacking or there is a history of abuse and neglect. There is no sense in creating a “safe therapeutic environment” for one hour a week if the remainder is spent in an environment that is not adjusting to the teen's needs or acting as an obstacle to progress.
Usually, this issue is not prevalent in established community based agencies, IOP programs, Partial Care Programs or state funded youth and family intervention programs. These entities are held accountable to external organizations who want results and are aware of the impact family involvement has in adolescent work. Also, many of these agencies adhere to best practice standards in order to remain compliant with accreditation bodies. Lastly, some of these agencies grew from a family systems framework and family involvement is part of their treatment DNA. Individual therapists or group practices are most likely to fall into the trap of minimizing family involvement.
When selecting a therapist for your teen, there are some things that may be important to be aware of and investigate.
Your teen isn't necessarily the problem- Adolescence can be a difficult time for your teen. Many times the inability of a family to accommodate changes needed for a teen to experience this phase productively or how the system around a teen reacts or responds may be counterproductive and contribute to undesirable behaviors, thoughts and feelings. Families of teens in therapy must be open to change and involved.
Your teen has the right to keep most information shared in therapy confidential-This doesn't absolve your therapist from encouraging your teen to share this information with you. One goal of therapy is to help teens and parents share symptoms, concerns and disagreements with each other in a way that is productive and safe. Therapists many times consider openness in therapy as a primary goal- this is a mistake. Obtaining a teen's trust is certainly key, but helping the family and teen get to a point where they can independently communicate to each other openly and safely is the desired end result.
A diagnosis doesn't make the family bad but it doesn't relieve the family of responsibility either- A teen diagnosed with depression, anxiety or some other disorder does not mean the family is dysfunctional. However, it does mean that the family may need to work differently and/or harder to look at how it operates so that the home provides an optimal environment for recovery. A diagnosis does not make the family or teen a failure.
A full session of family work should happen at least once a month-Of course there are a few exceptions that center around safety issues. Discussions with the family about the teen should include the teen. Meetings should not feel secretive and issues should be discussed openly and honestly. Your therapist should be confident and competent enough to facilitate these discussions. Parents encourage their teens into therapy because they feel as if their ability to handle issues are stretched- your therapist should help you gain mastery back.
Interview your therapist-Its worth the session fee. Ask about formal training in the area of adolescent and family work. Also inquire about your therapist's experience- a provider with experience in an outcome driven community based family therapy program usually means they've worked with some difficult situations and have received specialized training. A therapist should have no problem with a client asking for a resume.
The great majority of therapists who work with teens understand the importance of family involvement and are competent enough to provide effective treatment. The lack of formal family therapy training in some counseling disciplines and programs along with the lack of accountability many individual outpatient therapists and group practices have to external entities continues to be an issue however. When deciding on a therapist take the time to know their approach and be clear about your expectations around family involvement.
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