‘Nobody else can lead your life’: What adolescents need from psychotherapists in change processes

Abstract

Aim A startling number of adolescents have mental health problems, yet research on the effect of routine care shows sobering effect sizes and high dropout rates. This study's objective was to gain in‐depth, first‐person knowledge about what adolescents need from their therapists to engage therapeutically and benefit from treatment. Method A total of 22 adolescents aged 14–19 years participated in qualitative focus groups or individual interviews of their own choosing. The data material was analysed using a systematic, step‐wise and consensual qualitative research framework for team‐based analysis. Findings Six themes emerged from the analysis, named from the words of the adolescent participants: (1) facing a scary situation: Attend to the adolescent's starting point, (2) be warm, invested and emotionally engaged, (3) offer live company and presence as a real human being, (4) have integrity as an adult and a professional, (5) know the world of a teenager and get into their stories and (6) have mutuality as a virtue and treat the adolescent as an equal. Discussion and implications Overall, adolescents regard the quality of the therapeutic relationship with their therapist as essential for the success of psychotherapy. In terms of their needs in treatment, therapists need to overcome the adolescents’ initial misgivings and scepticism towards therapy through establishing trust and accommodating their developmental desire for autonomy and connectedness.

“It's like a refuge”: Young people's relationships with school counsellors

“…This study lends support to existing literature suggesting that young people prefer an informal relationship in which they feel able to establish a genuine sense of connection (Binder et al., ; Lavik et al., ). The young participants in our study particularly appreciated counsellors showing themselves to be “real” by, at times expressing vulnerability or disclosing personal information.…”

“…Research has also captured young people's sensitivity to power dynamics, suggesting that perceived imbalances can negatively impact on the therapeutic relationship (Binder et al., ; Bury, Raval, & Lyon, ; Everall & Paulson, ). In the recent past, Lavik, Veseth, Frøysa, Binder, and Moltu () also noted that counsellors needed to foster an environment of mutuality and be genuinely invested in the young person for the relationship to feel comfortable.…”

User participation and shared decision-making in adolescent mental healthcare: a qualitative study of healthcare professionals’ perspectives

“…A trustful patient-practitioner relationship is one of the most robust predictors for treatment satisfaction and outcome [25,41,42]. Similar to a study by Oruche et al [43], this study notes that treating adolescents as partners is necessary to improve their participation in decision-making.…”

Relationship in context: Processes in school‐based counselling in Hong Kong

“…Trust building was particularly important. Previous studies have emphasised the importance of developing trust in the formation of a counselling relationship (Lavik et al, ; Prior, ; Westergaard, ), and the present study’s findings suggest that developing trust is a significant precursor of relationship building with the counsellor and that the importance of trust is heightened by the Hong Kong sociocultural context.…”

“…The feelings of fear and uncertainty reported in previous studies as students first approach counselling (Binder et al, ; Lavik, Veseth, Froysa, Binder, & Moltu, ) seem to be magnified by the sociocultural context of Hong Kong, where trust outside the family is relatively lower than in Western cultures (Ward, Mamerow, & Meyer, ), with individuals having been socialised into the belief that sharing information of a personal nature outside the family is inappropriate or even shameful. Hence, students may fear that revealing personal information to others may damage family relationships and cause shame and loss of face (Kim et al, ).…”