Laurie L. Hayes, Special to Counseling Today
Thursday, December 13, 2001
"When counseling young people, therapists should prepare for an adventure." This according to John and Rita Sommers-Flanagan, who stress that cultural differences, coupled with the fact that many adolescents come to them against their will, should signal practitioners who want to work with this age group that there is rough road ahead.
To assist mental health professionals in avoiding some of the pitfalls to dealing effectively with this age group, the couple recently wrote a book, Tough Kids, Cool Counseling: User-Friendly Approaches with Challenging Youth. Published by the ACA, the guide draws on John's experiences as a clinical psychologist and executive director of Families First, a parent education program in Missoula, Mont. And Rita's work as an associate professor and director of counselor education at the University of Montana.
"The biggest fundamental difference between counseling children and adults is that adults come in voluntarily," said John Sommers-Flanagan. "Teens are much more reluctant to be in the office."
This is a significant difference when trying to build a working relationship with young clients, something that he and his wife believe to be essential to assessment, counseling and treatment. Because of this, Sommers-Flanagan places a lot of emphasis on rapport building - understanding and emotionally connecting with the youngsters.
Pam Paisley, an associate professor at the University of Georgia, agreed with the importance of establishing a rapport. She noted that with this age group, relationship-building if more critical and more time consuming that with adults.
There are many things that a counselor can do to facilitate this process, according to Paisley. Some are simple, some are more involved. Among the easier steps is making a space in the office that welcomes youngsters with age appropriate art, pictures or books, Younger children will appreciate smaller-sized furniture, toys or games. In addition, the counselor might also consider dressing more informally than usual or at least temporarily adopting a more youthful style.
In Tough Kids, Cool Counseling, John Sommers-Flanagan admits to keeping "a pair of beat up high-tops in his closet to wear when working with young boys who are impressed by expensive, well-worn sneakers. A female therapist who has established many positive relationships with young girls has earned the reputation from her clients for dressing "way cool."
"Above all, counselors need to project the right attitude," said Paisley, "Children have a great barometer for genuineness. If you find you don't really like working with them then it would be best to find something else to do."
The youth culture
Having the right attitude does not, however, guarantee that counselors will automatically know how to relate to kids, said John Sommers-Flanagan. "As counselors, we are all used to speaking with adults or having playful interactions with small children. With adolescents, it's hard to define how to interact," he noted, blaming this problem on the innate differences between adults and teens, stressing that in many ways, work with young people is multicultural work. In the book, this point is emphasized by asking how many adults get up at 3:00 a.m. to get tickets to a Pearl Jam concert, engage in burping contests or get harassed by bullies at the bus stop.
In counseling, teens are equally unpredictable, frequently clamming up during sessions or testing boundaries with irrelevant or inappropriate questions or comments. John Sommers-Flanagan noted that such behavior often earns youngsters the title of "treatment -resistant." A growing understanding of the cultural differences between adolescents and adults has lead him to believe that counselors may be equally "youth-resistant." At any rate, he stressed that the responsibility for making the connection and doing the therapeutic work falls on the professional, not the client.
Sommers-Flanagan begins this connection process with the first meeting. "I make a point of knowing their name before they come in," he said, "and I often greet them before their parents so they can see that I am oriented to them. At the outset, I talk more casually than I would with an adult, in a language that they are used to. I ask about goals for our meetings, and make a point to let the child or teen answer first, before their parents."
John Sommers-Flanagan admits that some might disagree with this approach, but he defends by noting that "After a child has heard their parents' answer, he or she is likely to either resist or mimic their response. Parents tend to have a long list of goals and I believe that what parents say will effect what a child says."
In response to their disclosure, he tells them, "My position is to help and support you to achieve healthy, constructive goals." He also lets them know that if their goals are illegal or destructive he will withdraw his support.
After addressing disclosure, a discussion of confidentiality is in order. "I tell them, 'If I meet with you and your mom calls and says, "What did he say?" I will not tell her,"' John Sommers-Flanagan said, while noting that a meeting with the three may be necessary at some point. Parents almost always agree with this level of confidentiality so tat their child is free to talk privately.
Paisley has also found parents to be receptive to the issue of confidentiality. "I walk them through the legal guidelines up front, telling them that I will talk about their child's progress in generalities but not facts," she said In some cases, youngsters have given their permission for her to share the details of their session. "If that is the case, as long as the child is comfortable, I have no problem," she said, "but most parents care enough that they respect the idea of confidentiality and recognize its importance to building a relationship with their child."
Both Paisley and Sommers-Flanagan agree that there are limits to confidentiality, however. "If I sense that the child is suicidal or homicidal, or is planning something cleanly dangerous, I will share that with the parents," John Sommers-Flanagan said. Also many states require counselors to report any discovery of current or past abuse, especially if there is a chance that another harmful act could occur. Other situations require a judgment call, he noted, relating a situation his wife encountered with a girl who had suffered repeated instances of date rape which she did not want to reveal to her parents.
"Rita [Sommers-Flanagan] finally said 'Enough is enough,' and told her parents," he said. "That was her last session because the girl refused to see her again."
John Sommers-Flanagan does not disclose recreational marijuana use or other similar behaviors unless they become destructive. Not surprisingly, this has prompted discussion about what exactly "destructive" means. "Many kids rationalize, especially with marijuana," he said. "But if I sense that there is a pattern of use, I will encourage the child to come clean with their parents."
This view of drug use represents yet another cultural gap between today's adolescents and adults, and also illustrates another point stressed in Tough Kids, Cool Counseling. That is, today's teens are not living the same lives their parents or other adults experienced when they were younger. John Sommers-Flanagan emphasizes this to dissuade both parents and counselors from what he terms "an erroneous belief that we can understand a younger human being's experience simply because we were young once too."
He stressed that when conducting similar therapy with adults, counselors are very cautious about assuming that they understand how someone feels, yet they may not hesitate to tell teens that they know what they're going through. This attitude will almost inevitably prompt the young client to respond, "You don't know what I think," Sommers-Flanagan noted. And in most cases, they're right.
"We need to be cautious about projecting our own experiences onto those of today's teens," he stressed, "because a lot of times that's not how it is." In addition, there is a tendency to edit our childhoods into something more idyllic than they actually were, greater an even bigger generation gap.
"Limited self-disclosure can be important, and from there you can certainly try to imagine what they are going through and show empathy for their situation," John Sommers-Flanagan said. "But you can never really put yourself in your clients' shoes."
"In certain situations it is helpful to self-disclosure," agreed Paisley, "but it's not something you should lead with. And even if we are convinced that we see a clear path out for the child, it is far better to help them learn to problem solve for themselves."
Respect and trust
Respecting the individuality of a young client goes a long way to establish trust, which the counselors agree can be one of the biggest barriers to building a relationship. "A number of teens that I have worked with have not had positive relationships with adults, which has taught them not to trust, Paisley said. "Counselors need to show that a relationship with them will be different from their past experiences."
"They expect us to be an agent of their parents or another adult who pushed them into counseling, and we have to do things to disprove that," added Sommers-Flanagan. "I frequently say, 'If I were you, I wouldn't trust me either. Wait a few sessions and see what you think.' By acknowledging and even encouraging their distrust, I actually get them to begin to trust me."
Once a trusting relationship has been established, in their book, John and Rita Sommers-Flanagan offer countless cognitive, behavioral, emotional and interpersonal techniques for working effectively with young clients, all of which continue the theme of "user-friendliness."
"User-friendly counseling strategies," they wrote, "are specially aimed at making counseling more accessible, palatable, sensible, and even enticing to young clients who are initially unenthused about participating in any kind of therapeutic endeavor." "Basically, when working with children and adolescents, we need to modify what we do to meet their needs, John Sommers-Flanagan said. "We can't simply address their issues from our cultural standpoint
"In the end, I really believe that a lot of them are glad to be there (in counseling)," he said. "When the session is over, they frequently linger or keep talking. These kids want adult support, we just have to figure out the best way to give it to them."