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Adolescents require differentiated care from that of adults, and not all professionals are willing to work with adolescents. Furthermore, if the truth were known, not all willing professionals are able to work with the challenges presented by teens. Perhaps as professionals we have researched the population we are going to work with, acclimating ourselves to the treatment interventions, methods and procedures. We present such a professional facade that adolescents are not able to get past the “lab coat trauma” to find the vulnerable person inside. In our excitement to help, we may not anticipate how we get in the way of ourselves.
At times we initiate a set of circumstances that almost guarantees failure, and our resulting frustrations can affect how we approach the adolescent. Almost every young person considers it his or her job to challenge authority, and all teens arrive quite honestly to this confrontational stance. Frustrated parents find it impossible to deal with acting out behavior with gentle actions of love, and teens are not always able to make appropriate decisions consistent with the situation.
Two areas that seem to make a great deal of difference in my ability to work with adolescents are:
1) Building Rapport:
Keep in mind that professionals are categorized in the adolescent mind as authorities. A lot of acting out may be caused by simple fear instead of rebellion. If we don’t hear what they aren’t saying, we spend a great deal of time with superficial issues. As the professional we should remain calm and in control of reactions while attempting to stay out of poser struggles. If we get caught up in the poser, we have lost.
Develop realistic communication, be consistent, and help teens to understand that they have some control over their treatment. Respect them as people, and respect their culture even when you don’t agree with it. Building mutual respect is laying the framework to engage them in treatment. Once the door is open for trust, they will start to respect you, others and themselves. This is an ongoing process for which they require your mentoring. Furthermore, remember that they are observing your every nuance of body language and vocal tone. We are teachers and role models in the arts of communication and dealing with daily issues.
2) Attending:
It is vital to show concern for the client’s needs and feelings. We must be genuine in our conversations with them, for they can spot a phony quite easily. Honesty and respect will encourage adolescents to express themselves, explore new ideas and take responsibility for their own actions and behavior. They need our help to find some motivation for wanting to start in recovery, and they will be expecting validation for progress, which will empower them to take risks and learn new perspectives about life and maturing.
Be aware that when we don’t see the adolescent making significant progress, we may tend to feel frustrated, blaming the clients for their lack of progress. Keep in mind that apparent absence of improvement could be caused by multiple reasons, including our inability to move the adolescent down the recovery road. If we blame the adolescent for being resistant, the issue then becomes one of control. The more we attempt to build mutual respect, talk with the adolescent and not down to him or her, while showing sincere concern, the saying that “There is no resistant client, only resistant staff,” becomes more appropriate
The differences between treating chemically dependent adolescents and adults present a unique set of challenges for the professional. Whereas treatment of adults is a rehabilitation process, adolescent treatment considers habilitation, catching the adolescent up with his/her skills. In approaching the adolescent, one must:
- Have a good understanding of adolescent development.
- Invent ways to connect with teens and develop the protocol to help adolescents deal with all life areas.
Acting out behavior is a coping mechanism that seems to come naturally to the adolescent. When developing clinical directives, we need to consider the chemical dependency, adolescent development stage and any other diagnoses. All concerns should be addressed concurrently to maximize the opportunity for treatment success.
The focus on adolescent treatment should be on responsible behavior. Is the adolescent exhibiting a desire to solve his/her own problems and take responsibility for choices and potential consequences? Abstinence is the goal, but focusing only on abstinence tends to lead the adolescent to be more rebellious, for he or she is experiencing daily reality, which can be painful and overwhelming. Professionals must bear in mind that treatment for a youth is both educational and experiential, requiring time for the client to learn how to apply recommended procedures in his/her daily life.
It is best to use interactive learning methods with adolescents. They nearly always respond to metaphors and situations that pertain to their lives. While treatment is serious business, there should be an element of fun that can engage the adolescent. Also, family and group therapy combined with individual therapy seems to be most effective in dealing with the interaction of adolescents with their families. In both group and individual therapy, adolescents should be addressing the issues behind their substance abuse. Issues such as self-confidence, power, fitting in with others and how to gain power in their lives must be considered.
Certainly adolescents may rebel against authority and rules, but they need the structure in their lives to feel secure and safe in order to progress through their developmental stages. Therefore, effective treatment of an adolescent always hinges on applied professional treatment. Inevitably, adolescents become engaged by treatment from adults that respect them, are honest and understand adolescent issues and problems.
It is in my experience that working with adolescents brings out the best qualities as well as defects of character in both client and therapist. By taking his or her own good advice and remaining teachable and open to change, the professional can eliminate much stress and gain the opportunity to be a better therapist.
Bob Gilroy is a Certified Addictions Counselor who has worked in the addictions field for 15 years, his present position at the IIAR is corporate services clinician. Mr. Gilroy is an advocate for prevention services and has been involved in the Illinois Teen Institute (ITI) since 1984. He also serves on the board of Illinois Drug Education Alliance (IDEA), which monitors the types of substance-abuse legislation that comes before state legislators.
Resources
Tammy Bell, Director of Adolescent Services for the CENAPS Corporation.
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