Substance Abuse Counseling for Teenagers
I never met a teenager who thought counseling for their substance abuse problem was a good idea. If they actually went to a therapy session at all, it was because it was court ordered. But they sure as hell were not going to talk about a drug problem they were pretty sure they didn’t have.
“I just wanted her to shut the f… up.”
An anonymous teen, referring to her court-assigned therapist
Counseling is a good idea for teens with substance abuse issues, isn’t it? Then why do they hate it so much? Besides the fact that it wasn’t their idea, that they are pretty sure they don’t have a problem, that they don’t want to talk to a stranger, that they don’t want to be in anyone’s office, and that they basically just don’t want to talk, what else could it possibly be that makes teens so resistant to counseling as a means of helping them kick their drug habit?
Most teens are automatically pretty protective of their “emerging self-hood,” explains teen therapist, Janet Edgette, in “Mistakes Therapists Should Avoid.” And they loathe counseling sight unseen, and even more so if their first taste of the effort was a sour one, adds Edgette.
They especially don’t want to talk about their feelings, says Edgette, especially not right off the bat. “Direct questions about feelings are actually a source of irritation to kids,” Edgette concludes.
“Most kids don’t give a crap about their unconscious conflicts…treatment goals…or anything having to do with therapy…”
Janet Edgette, teen therapist
But teens by nature are rather curious creatures, Edgette points out. I learned good therapy begins with getting kids curious about what we might talk about in the next session, so they want to come back. So I chat, joke, argue, and say things that get them to relax, lower their guard, and talk about things they are interested in, explains Edgette.
Basically, their resistance to counseling is based on their fear of losing control, of being exposed, and having some kind of judgment pronounced on them, Edgette suggests. My job as a therapist is to help them get less afraid.
Natural Law Therapy
Natural Law Therapy posits that therapy should be conducted as much as possible like the natural way people talk to one another, contends Edgette. No rules, no norms, no protocols, and no scripts. Establishing an easy rapport is the first order of any hoped-for successful therapeutic endeavor. But such has to grow naturally out of mutual regard and respect that people who talk together develop…over time.1
Teens React Differently Than Adults
With teens, when therapists identify inconsistencies or even connections in comments they make, instead of appreciating the keen insight of the therapist, they tend to resent the perceived “correction” and retreat into the safety of being silent again, further explains Edgette.
“The idea that rapport leads to engagement is exactly backward. You engage and, if you like what you see in the other person, you connect. Then you have rapport.”
Teens will fight to the death any comment that sounds like judgment, especially as it pertains to rules a therapist might hold with regard to using profanity, making rude comments, or directing insults in the midst of dialogue in a therapy session. It also refers to any effort on the part of the therapist to cast aspersions of inappropriateness on or disapproval of behaviors shared by teens in counseling, like getting stoned, having sex, shoplifting, or even using violence.
Not Taking the Bait
Some teens talk too much, especially about those things they think the therapist is wanting to hear or to simply get their attention. They thrive on the urgency and the insistence of adult reactions. Such reactions are actually gratifying, explains Edgette. They love the alarmed look that comes over adults faces when they talk of cutting themselves so they can go to sleep, or how many people they sleep with at one time, or even how many shots they drink to get a buzz. The key to this kind of talk is to not react with any kind of obvious alarm. The goal, Edgette suggests, is to not respond in a way that makes the conversation about the therapist’s values, but more on the generalized thoughts related to the matter at hand that the teen client has.1
Some troubled teens use the threat of volatility to keep others from engaging in meaningful conversation with them. They use the threat of blowing up in someone’s face to protect themselves from having to open up and engage their own way of thinking or acting. It is a way of avoiding being vulnerable, which is what is required to do any kind of significant self-examination. The effect it has on others is that when they are around they try to not say or do anything that might cause an explosion. It is literally like walking around on eggshells. The key, Edgette says, is to pick your battles, when what you believe or stand for is opposite that of the teen, and you stand your ground in a way that does not personally judge the teen’s stand, but lets them know that you simply don’t agree with them.1
Meeting Kids Where They Are
Some teens remain aloof or remote so as to minimize the possibility of engagement with others. And for those who dare to attempt to talk with them, they will defend themselves by proclaiming a practically indefensible negative position that most would then choose to cease efforts to engage with any further. Efforts to challenge the teen’s negative stand will only be met with him or her walking away and ending all conversation completely with absence. The key, says Edgette, is to meet them where they are, to “normalize” the negative statement, joining the teen in what was said instead of confronting it. If the teen says, “I hate everybody,” the engaging adult can simply begin by saying something like, “I have days where I hate everybody too.”
Alter Your View of What Instances of Teen Resistance are All About
More often than not, resistance is looked at as something negative, as something to be challenged. The problem with this view is that it takes the focus off what the root cause of the resistance is in the first place, and then nothing can be learned about what underlies the behavior. Try altering your view of resistance in this regard. Think of it as a protective mechanism, and focus on what the teen in question might be protecting psychologically. Taking this point of view will allow you to be less reactive to the teen, less demanding, and more observant.2
“Working with teens can be a very fulfilling and rewarding endeavor. It can also be very challenging. Teens can test boundaries and become resistant to counseling interventions, classroom curriculum, or even towards us as adults personally.”
Sam Himelstein, Ph.D.
Mindfulness is the practice of being present in the moment, present to your own experience (your thoughts, emotions, sensations, etc.), and with an attitude of non-reactivity. What that means is when anger or frustration or anxiety arises as a result of a teenager presenting with resistance, rather than quickly reacting to those emotions and saying or doing something regretful, take a few breaths, note the experience, let it ultimately pass away, and then respond. this can be easily initiated by focusing first on your breathing. Note your breathing in, and then your breathing out. You can do this through your mouth, your nostrils, your chest, or even your stomach.2
Reflective Statements and Questions
When it’s time to finally say or do something to the resistant teen, speak calmly, make no demands, and maintain a respectful tone. You don’t want to give the youth in question anything negative to fight against. It can be the difference between settling things down or causing an eruption, leading to further resistance. In this manner, use nothing but reflective statements and questions, like “I can see you are upset,’ or “What’s the matter, big guy?” The goal is to get him or her to talk it out, the get it out, to breathe, and to eventually calm down enough to get some perspective.2
Forcing Resistant Teens to Go to Counseling
Almost never! Forcing your teen to see a counselor isn’t likely to be effective. Most anyone who feels forced to get treatment isn’t likely to be motivated to change. Even if court-ordered, teens dragged to their appointments aren’t likely to talk about much of anything in a productive manner. There will be times when your teen needs help regardless of whether he agrees, and a little arm twisting may be necessary. Of course, if your teen is at risk of hurting himself or someone else, call 911 or take him or her to the emergency room. There will be times when treatment is mandatory when a teen is not capable of making healthy choices on his or her own. Certain forceful measures may then be necessary.3
Involving Resistant Teens in the Early Decision Making
Let your teen first know you love them and want the best for them. Then share your thoughts and feelings on why counseling is important and how it could be helpful. Ask ahead of time that they listen to you, and promise you will do the same when it is their turn to talk. Then ask your teen for their input, what they think and feel. Follow through on your promise, and listen without comment or judgment.
Tell your teen you think they need help, and why. Ask them if they think they need help, and why or why not. Most importantly, listen. Make sure you let him or her know that you are not embarrassed or ashamed of them. Ask them if they feel embarrassed or ashamed to admit they have a problem. Listen.
Involve them in the discussion and decision making from the very beginning. Ownership comes from being there at the start and taking ownership, not just buying in after the fact and accepting what others decide.3
What the Doctor Says Can Be Important
Talk with your teen’s doctor, both you and your teen. By talking to your teen’s primary care physician, related medical needs can become part of the overall discussion and help to further solidify your teen needs counseling. If more complex treatment is necessary, a doctor can identify the most appropriate services and treatment professionals available. Also, if your teen isn’t willing to listen to your recommendations about counseling, he or she may be willing to listen to his physician and take the discussion that much more seriously.3
There’s never a final word. Never give up. Barring the worst possible outcomes, the worst that can happen next is that your teen will know that you never gave up, even if he or she did not get the help they needed. If your teen refuses to go to counseling, you still have several options at your disposal.
Talk to counselors on your own without your teen. Get their advice. See what they say you can still do. Build your confidence in what you think and feel. Get parent training if need be. And make sure you let your teen know you are going to talk to a counselor, whether he or she goes or not. And let them know why. Let them know that at least the counselor will hear the parent side of the story.
Talk to the school guidance counselor, and make him or her aware of what’s going on. Consider confidential options at school your teen may or may not know about. Your teen might well be willing to talk with a counselor at school. At least it’s a positive place to start the process.
Consider establishing a contract with your teen. Negotiate a reward-based contract for a certain number of sessions, at least two, before deciding it’s “no go” on counseling. Then follow up with a discussion about pros and cons, and going for more sessions.
Check out online counseling. Sometimes, teens who won’t speak to someone face-to-face will talk to a therapist online. It might do the trick to get him or her talking. The anonymity and the confidentiality might feel safer.3
Whether the substances being abused are alcohol, illicit drugs, or prescription or over-the-counter medications, don’t give up. Counseling is the key. And participating with the right attitude is the door that key can open.
Although substance abuse in this country is reported in numbers and percentages, always remember that the person in need is your child, not a number or a percentage.
You, of course, love your children the way they are, but you love them more than that such that you refuse to leave them there to stew in the dangers of continued substance abuse.
1 “Why Teens Hate Therapy,” Janet Edgette, Psychotherapy Networker, 2012.
2 “3 Tips for Working with Resistant Teens,” Sam Himelstein, Ph.D.
3 What to Do if Your Teen Refuses to Go to Counseling,” Amy Morin, LCSW.