Therapy with Teens and Their Families

The Treatment of Teens and their Families

Teens experience more stress today than any other time in history, as the internet has literally changed their world. Stress wears on a person emotionally, mentally, physically and spiritually. “Stressors,” or psychosocial and environmental stressors, refers to people, places or things surrounding an individual and exerting excessive pressure. This pressure is internalized by the individual and experienced as worry, stress or anxiety.

The following are examples of stressors felt by teens today:

• School and homework
• Parental divorce and blended family issues
• Fitting in with their peers
• Developing friendships
• Responsibilities beyond their age
• Pressure surrounding drugs and sex
• Emotional and physical abuse
• Adjusting to change, such as two households or multiple schools

It’s no surprise that anxiety and depression are the most common disorders treated in private practice — they are the opposite side of the same coin. As one experiences increasing degrees of anxiety, the individual will ultimately feel hopeless and helpless, two common symptoms of depression. You can think of depression as one foot in the past and anxiety as one foot in the future. Feeling regret or guilt from their past and/or worry about what tomorrow is going to bring their way can be challenging for teens to handle on their own.

Trying to manage all the demands of adolescence often results in anxiety and depression, as well as the following:

• Low self esteem
• Drug and alcohol use
• Non Suicidal Self-Harm
• Emotional eating
• High-risk sexual behaviors
• Lack of confidence
• Family discord

Treatment for these conditions include medication, individual and family therapy, and group therapy. Over the last 30 years that I have been a Licensed Marriage and Family Therapist, the number of teens on medication has increased substantially. Consequently, I work closely with medical doctors and psychiatrists when appropriate. Some of the disorders being treated with medication include, ADHD, Generalized Anxiety Disorder (GAD), Persistent Depressive Disorder (PDD) and Major Depressive Disorder, and OCD. My experience has shown me that although medication can be very helpful and in some cases necessary, medication along with a psychotherapeutic approach, such as CBT, may be a more effective means of treating the teenager and preparing them for life rather than just relieving the symptoms.

The treatment of teens and their families can often be expedited by family therapy. Medication, group therapy and/or individual therapy, when combined with family therapy, make up a multi-faceted treatment approach. I work to assess which modalities are appropriate at any given moment and consistently reassess in order to be sure that the best interest of the child is being served. Some teens may also require the therapist to interface with teachers or school counselors who may develop an IEP, or Individualized Educational Plan, for a teen who is struggling at school. It may also be necessary to have the teen evaluated by a psychologist who can provide a complete assessment of the teen in terms of mental and emotional capabilities or deficiencies. Needless to say, working with teens and their families can be challenging for the therapist, who not only needs to coordinate these treatment modalities, but who also will field many questions from anxious parents or teen clients in crisis.

Family therapy can include education for the entire family in regards to the client’s disorder. This can help to normalize the view of the client’s symptoms, provide a sense that the family is not alone, and instill a new found feeling of hope. Family therapy is also a means of identifying the communication patterns, boundaries and roles in the family. There may be mutual or open communication between siblings and parents, but not with the client, who becomes the IP, or “identified patient.” This can result in permeable boundaries for the siblings and impermeable boundaries for the client. Thus, the client may feel shut off or alienated by the rest of the family. However, the siblings may be parentified, or given parental responsibilities at a young age, which can result in pressure on the whole family. And, within this system, roles may emerge. Members of the family may be seen as the hero, scapegoat, or mentor, for instance, and expectations of their behavior develop. Therapy helps to identify these patterns of communication, boundaries, and roles, and how the system itself may inadvertently support the symptoms of the client. This awareness can help to defocus the client as the “problem” and reframe the family dysfunction as no one’s fault, as it is not focused on only one member of the family.

Each teen is different and deserves a unique treatment approach developed by a skilled clinician. With these factors in place there is hope for families suffering from the symptoms and disorders experienced by so many of today’s teens.

When to Seek Help

Deciding to seek assistance from a professional can be a difficult decision. Some situations require immediate, critical assistance (such as having suicidal or homicidal thoughts or actions including non-suicidal self harm) while others are less threatening but would benefit from guidance from a professional. Generally, if your teen has been feeling very stressed, depressed, worried and/or anxious over a few weeks AND it is beginning to interfere with their life and the usual coping skills have not been able to solve the problem, it would be advisable to seek a professional therapist.

Do You Require Immediate Help?

If you (or your child) are having suicidal thoughts or have expressed suicidal intent or the intention to harm someone else, you should call 911 or go to your nearest hospital IMMEDIATELY!