Therapeutic Engagement With Adolescents in Psychotherapy.

Abstract

Therapeutic engagement of adolescents is critical to maximizing the success of any psychotherapy intervention. Therapists have found that engaging adolescents is especially challenging and that there are several reasons for this. Most psychotherapy models are based on treatments that work for adults. These methods are frequently not conducive to engaging adolescents because of their developmental immaturity, the stigma many adolescents associate with psychotherapy, and adolescents feeling forced into psychotherapy. Existing empirical and clinical knowledge about therapy process, adolescent development, and adolescent interactions with their social ecology can be used to guide psychotherapists working with this population. Engaging adolescents in psychotherapy and establishing a strong therapeutic alliance with adolescents require that therapists express empathy and genuineness, utilize developmentally appropriate interventions, address the stigma, and increase choice in therapy. The prevalence and impact of mental health issues among adolescents are astonishing. Recent reports indicate that 1 in 10 children and adolescents suffer from impairing mental illness (Kessler, McGonagle, & Shayang, 1994; U.S. Public Health Service, 2000). Depression and depressive syndromes are common among adolescents, with more than 25% of high school students reporting persistent dysphoria and hopelessness severe enough to affect social and academic functioning, and 8 to 9% of youths admitting to attempts at suicide (Centers for Disease Control and Prevention [CDC], 2002). Five percent of all high school youths report weight control strategies that indicate a potential eating disorder (CDC, 2002). Nearly 27% of eighth graders, increasing to nearly 54% of high school seniors, report illicit substance use (National Institute on Drug Abuse, 2001), with 11% of high school students having a substance abuse problem.These mental health problems lead to serious consequences that include impaired social, academic, and occupational functioning; increased risk for behavioral problems; and accidental injury and death. Yet, fewer than one in five youths in need of mental health services receive the needed treatment (National Institute of Mental Health [NIMH], 1999). So, while adolescent mental health problems are pervasive and increasing, access to treatment is decreasing (NIMH, 1999). Consequently, maximizing adolescent use of psychotherapy and providing effective mental health services to adolescents are significant concerns for therapists (Dakof, Tejeda, & Liddle, 2001). However, therapy with adolescents is thought to be difficult (Church,

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

“…This is in keeping with other findings showing that adolescents respond positively to therapists who validate their experiences, provide stress-relief and fosters positive motivation for change already in session one (Russell, Shirk & Jungbluth, 2008). Overall, adolescents need their therapists to be empathic and proactive in building therapeutic relationships (Oetzel & Scherer, 2003), and our findings strongly suggest that being genuinely caring, committed and engaged as a therapist is especially important to accomplish engagement and rapport in adolescent psychotherapy.…”

“…Other studies show that receiving full, accepting attention from the therapist helps adolescents express themselves openly in therapy (Sagen, Hummelsund & Binder, 2013), and that adolescents tend to view themselves as active agents and shape their construction of therapy to match their own priorities (Gibson & Cartwright, 2013), underscoring the importance of agency. In summary, it appears that a strong and mutual therapeutic relationship needs to be established for adolescents to truly engage and become active agents in their own therapy process (Oetzel & Scherer, 2003).…”

The Experience of Forming a Therapeutic Relationship from the Client’s Perspective: A Metasynthesis

“…Despite some authors arguing for the inappropriateness of this stance (Eyrich-Garg, 2008), it likely reflects these clients' wider experience of feeling powerless during a phase in their lives where they are striving to become more autonomous (Oetzel & Scherer, 2003). This sense of powerlessness and the emphasis on mutual respect were also apparent in the studies involving clients from a racial or ethnic minority background.…”

Therapy Expectations of Adolescents with Depression Entering Psychodynamic Psychotherapy: A Qualitative Study

“…There are unique attributes associated with the phase of adolescence, like having difficulties integrating the need for autonomy and needs for help (Bolton Oetzel & Scherer, 2003). Furthermore, the psychotherapy setting may feel too demanding, for it often requires "that clients have the ability to self-reflect, manipulate complex concepts mentally, bear in mind the future consequences of behaviour and consider the perspective of others, Therapy expectations of depressive youth 6 while experiencing intense emotions" (Bolton Oetzel & Scherer, 2003, p. 220).…”

“…Reasons for non-engagement include fear of stigmatisation or lack of knowledge about therapy (Bolton Oetzel & Scherer, 2003). Being well-informed about what is going to happen in therapy and what to expect could play a crucial part not only in entering and remaining in therapy but also in the success of treatment.…”