ALCOHOLISM TREATMENT: GENERAL CONSIDERATIONS IN WORKING WITH ADOLESCENTS
Posted: July 18th, 2011 | Author: admin | Filed under: Anti Depressants-Sleeping Aid | Comments OffIn working with an adolescent, it is wise to avoid obvious authority symbols, such as white coats, framed diplomas dripping off the walls, and a remote clinical attitude. Adolescents are probably already having some degree of difficulty with authority figures anyway, and they don’t need you added to that list. Being somewhat informal in dress and setting can remove one barrier. On the other hand, spiked hair, playing tapes, sitting on a floor cushion, and sucking on a “roach” when they arrive won’t go down very well either. They want you to know about those things, but not be into them; unless, of course, you really are (even then, leave the roach at home). An attempt to fake out the adolescent will fail. They are a hard group to fool, and they place a high premium on honesty. Respect this and honestly be yourself. This means asking for a translation of their vocabulary if you are not familiar with the lingo.Empathy rather than sympathy is the goal. This is true of all therapeutic relationships. Sympathy is feeling like the other person. Empathy is knowing how the person feels, understanding it, but not feeling like he does at the moment. For instance, it is simply not helpful to be depressed along with the person.In general, three types of therapy are done with adolescents. One involves manipulation of the environment. This can include arranging for the father to spend more time with his child, getting the kid who hates Shakespeare into a different school program, or organizing a temporary placement for the child whose parents are nonsupportive at the time. These can be very valuable interventions.Standard insight therapy—psychological, psychiatrically oriented traditional therapy—is not often used. Not many adolescents are ready for, or even could benefit from, this kind of therapy. The ones who can benefit from it tend to be “bright,” advantaged young people, who seem more capable and older than their peers or their chronological age would suggest.The most commonly productive therapy is what could be termed a relational approach. This requires time for you to become well acquainted and for the adolescent to feel comfortable with you. The counselor is supportive of the person without doing it for him. The counselor is a neutral person, available to the adolescent in a very different way than are parents or peers.The issue of confidentiality always comes up. It can be a mistake to guarantee that “nothing you say will ever leave this room.” The counselor does have the responsibility for others as well as the adolescent client. Given blanket protection, what happens when the kid announces he plans to rob the local deli, or another says she plans to drive the family car off the road at the first opportunity? A different approach was suggested by Dr. Hugh MacNamee. His practice was to tell whomever he saw that though most of what they said would be held in confidence, if they told him anything that scared him about what they might do, that would be harmful to themselves or others, he was going to blow the whistle. He made it clear he would not do so without telling them; nonetheless, he would do it. In his experience, adolescents accept this, maybe even with relief. It may help to know that someone else is going to exert some control, especially if they are none too sure about their own inner controls at the moment.In a similar vein, Dr. MacNamee would suggest keeping the adolescent posted on any contacts you have with others about him. If a parent calls, start off the next session by informing the adolescent, “Hey, your Dad called me, and he wanted….” If a letter needs to be written to a school, probation officer, or someone else, share what you are writing with the adolescent. The chances are fairly good his fantasy about what you might say is worse than anything you would actually say, no matter what the problem. Because trust is such an issue with adolescents, it is important that you be willing to say to them what you would say about them behind their backs.Although the aforementioned is a good general approach to the issue of confidentiality, you may need to be aware of other complicating factors. In particular, we refer to the legal issues of a child’s right to care versus parental rights to be informed. There may be circumstances in which an adolescent has a legal right to be seen and treated without parental knowledge or consent. In any case, the ground rules you are following must be clear to the adolescent client.*150\331\2*
