I’ve been thinking a lot about some of the young people and families I’ve been lucky enough to work with over the years. For a wide variety of reasons, in the early days of when we were getting to know each other, it felt like we were all moving from one crisis to another. I’ve often described it as feeling like firefighting, except when one fire seems to be extinguished them another pops up somewhere else or the same fire reignites again.
At times like this I think it would be understandable if the young person, parents, and even myself sometimes wondered “what are we even doing here, is seeing this Psychologist / therapy doing me any good?” What I do know is traditional session by session manuals don’t feel like the right response. What manual will cover what to do or even where to start when a young person and their family is in a self-harming, drinking to excess, restricting eating, wanting to die (sometimes all of these all at once) time of their lives?
Reflecting back over young people who have come through crisis after crisis, sometimes life threatening, I think I’ve realised that there wasn’t a specific therapeutic technique I used that guaranteed success, I’ve looked back through my notes and memories and wondered “what did I actually do?”. What I think worked, was walking the path with the young person & trying to be the safety net for when, not if they fell. Pulling them back to standing, dusting them off and setting off along the windy path of adolescence together again. In any long journey there are inevitable bumps or potholes on the road and even more inevitable are tensions in the relationship. Therapeutic relationships are not immune from tensions….
In some ways I would argue that it is perhaps more therapeutic in the longer term for there to be some tensions in a therapeutic relationship with a teenager. Many of the young people I work with, to put it mildly, are not very fond of themselves. All they can often see is flaw after flaw, real or imagined, it feels very real to them. They can act in ways that they think is protective for them, push people away believing if they don’t that they will be hurt, again, so they do whatever they think they can to protect themselves.
When you really struggle with insecurity, when you think that everyone around you is judging you and wants to or might hurt you then you’re constantly on the defensive, much like the puffer fish above. How many parents (or therapists) have said something they thought was minor and the teen in front of them blows up with rage. To the adult it makes no sense, to the internal world of the teen, the words or the look threatened their already fragile sense of themselves and they respond the only way they know how, attack.
When this happens in a therapeutic relationship with a teenager I usually see it as a positive opportunity. It helps me to know how fragile, how vulnerable the young person sitting opposite me feels. On a broader level it also gives me an opportunity to challenge one of the primary fears that they young people have, that they will be rejected. If someone was to see the “real, raw, unfiltered, true” versions of the teenager then of course they will reject them. When you don’t reject them, no matter how much hurt they throw your direction, when you say “see you next week”, it both confuses and contains them at the same time. You’ve conveyed the message that you can see beyond the outward hurt they’re throwing your way, you can see the pain that fuels it, you understand it and you and your relationship can survive it.
As a therapist what you’re hoping the young person experiences is that I’ve thrown everything in my arsenal at them, they’ve stuck with me through every crisis I ever thought I would or feared I might experience and they’re still there, they still want to see me, to listen to me, to help me. Maybe I’m ok, if #onegoodadult can stick with me no matter what maybe there’s hope that others might stick with me to, just maybe.
Many young people feel like they are in an emotional hell at times during their adolescence, and for some it’s not just a perception, it’s their reality. One approach we could take is to advise them to keep going, to have hope, push through on the promise that things will eventually get better. My view is that it’s better to feel that hell with them, to try to understand their pain, and to walk through hell with them, not directing and telling them what to do, but gently guiding them to a pathway of recovery. This won’t be a surprise to anyone who works therapeutically with another, but when you look behind every successful outcome for someone in therapy, there will always be one key ingredient that helped foster that outcome, the relationship. Maybe just being there, walking that path together is the key ingredient, don’t underestimate it’s impact, I try not to.
Just surviving the trials, tribulations and sometimes hell of adolescence might not on its own feel like much of an achievement. Why shouldn’t we be aiming for happiness, contentment, achievement?But considering the pain some young people endure and survive, sometimes against all odds, maybe its more than an outcome than we give it credit for, maybe it’s good enough for now and the achievement of survival can build the foundation for hope of better to come? Maybe.