Therapy: A Teen Owner’s Manual

I often meet with new teen clients who are mystified about how therapy works. This is understandable—anything new can be confusing.  And for most teens, the medical professionals in their lives do things to them—check their blood pressure or clean their teeth, for example. So it is easy to think this would be true of counseling, as well. Given all of this, it is a common phenomenon for a teen to arrive in my office and sit quietly and, well, wait.

It is important for you to know that going to therapy is different from seeing your regular doctor. When you are in therapy you and your psychologist work together to help you tell your story and sort through your challenges. Here are a few thoughts about how this process unfolds:

              1.       Therapy can feel awkward at the start: You probably have friends or family members you trust. Trust makes it easier to                              confide in them. As a rule this kind of trust develops over time, but when there is a good match between a therapist and a                          client, it can develop more quickly.

                       Since trust and engagement are really important in therapy, perhaps your first task will be to figure out if you are                                          comfortable enough to connect with me. If you can see that happening, that is terrific. If not, I will absolutely help you find                        a psychologist you do feel comfortable with.

             2.       It helps if you can figure out a few goals of your own: There’s a good chance your parents were the ones who made the                            first decision that got you into my office. I am going to encourage you to make your next decisions about being here. That                          can start with coming up with a few goals of your own for our time together. If you aren’t sure what those might be, we can                        work together to figure them out.

                      There are lots of important reasons for you to goal set. First, I can’t really know what you want by looking at you! Secondly,                         if you have goals, you have ownership over our time together, and we will have a common language for measuring your                               progress. And (perhaps most important) learning how to set goals—both big and small—is a good thing for right now in                               your life, and a great skill to have for your future.

                     Goals are as varied as clients—they can be anything from managing your mood or anxiety to figuring out important plans for                      your future. In between lies everything from navigating sibling, parent and friend relationships to finding an internship to                          enjoy over the summer. Really, the sky is the limit, but the therapy process works best if you know a bit about your sky!

            3.       Silence can be good: Sometimes we hear our own ideas best if there is a bit of quiet in the room. Everyone is different in                            this way, but thinking quietly from time to time is good for many of us. I am not uncomfortable with productive silence, and                      therapy can help you develop this comfort, too.

           4.       Sometimes we don’t know what we think or feel until we say it out loud: Know that therapy is not a test with right and                          wrong answers. At times we have to put our hip waders on and slog through a certain amount of confusion together. It’s part                      of the process.

           5.       I may give you homework: Don’t worry, I am not going to ask you to write a paper, and there are no grades in therapy! But I                      am likely to ask you to try some new skills, and those assignments may vary depending on what is happening in your life.                            So at the end of many sessions we may come up with a small project or little experiment for you to try during the week, and                      I will ask you about it the next time I see you.

What will happen in our first session? First, you’ll arrive a little bit early to take care of some paperwork. If a parent organized your first appointment, it is likely that we will sit down together with him or her for some of our first meeting, which will last for one hour. During that time I will listen to their reasons for calling, and will ask the same questions of you that I ask of them. Before I send them out of my office to wait for you I will explain confidentiality with teens (you can find this explanation elsewhere on my website). You and I will spend the rest of the session together, getting to know one another and working to help you articulate what you hope to get from therapy. After our first appointment we will generally set up a weekly time to meet, and those meetings will last for 50 minutes.

Do I have to be sick to see a therapist? Sometimes people come to see me because they have a diagnosed problem, but most of the people I see in therapy are just like anyone else—trying to sort out a problem or a goal in life, perhaps feeling a bit stuck in the process. You do not have to have a diagnosable mental disorder to benefit from psychotherapy, and sometimes catching a problem early can keep a bigger issue from developing.

Will you tell my parents about the things we discuss? Psychotherapy with teens is like psychotherapy for anyone else—feeling you have a private place to talk about whatever is on your mind is important. Because of this I generally tell parents that what we talk about will be just between us unless I am worried about your safety in specific ways. You can find out more about this by looking at Confidentiality and Your Teen under About Me on this website.

How long will I see you? To some extent, this comes back to goal setting. You may see me for a short time if you are trying to solve a specific issue, like sleep problems. Our work together may take longer if you are managing depression or anxiety, or learning to live around challenging family concerns. Sometimes therapy lasts for weeks or a few months, and sometimes longer. You will know when you are finished, because the concerns that brought you to see me will be improved.

I hope this description has helped you understand how therapy begins. If you have questions about any of this, you should feel free to call me at 503-490-5793.