When I first decided to go into the field of mental health I was in high school and I knew, even then, that I wanted to work with teens. I was one of those “I want to be the person I needed” even while I still needed that person. It’s not a new story, but I do think it’s an important one.

Why Teens? There’s something magical about working with teens, some combination of a continued raw connection to emotion, strong walls and very gooey centers, the whole of possibility before them. And, in a more personal way, my teen years were when everything could have changed for me, and when I’m sure a lot did due to having a great therapist at the time.

I don’t know what I would have done if Dr. W didn’t see teens when I was one, if there were in fact no therapists who saw teens (and did things like take my insurance, see folks in person, and work well with teens. We’ll talk about that last one later.)

I’m finding less and less people willing to work with teens and it honestly worries me. So, let’s talk about some of the reasons I hear that people won’t work with teens.

But Sabrina, the parents!

I know, I know, the parents can be hard. The issue is, the kids with the hardest parents need us most. Learning to work with the parents of teens and the dynamics of the parents with the teens is some of the most important work you can do, in my opinion. It impacts every person, because everyone has been, is, or will be a teenager and every teen has adults in control of their life.
Sometimes, the hard part about working with the parents of teens is work we ourselves haven’t done about our own parents and teenagerhood. Reflecting on our own relationships, patterns, and experiences is always invaluable. Recognizing where and how countertransference may come up when it comes to parents, when it stops us from supporting a population desperately in need of good therapists, it’s non-negotiable.
2. What about when they don’t choose it?
It sucks that adolescents don’t get to control if they’re put in therapy. And sometimes they don’t even need it, their adults put them in for whatever reason they have. This leads to more frustration, silent sessions, and tough conversations with their adults. It’s hard to work with people who don’t want to be there. Some find it to be unethical even. You know we don’t do black and white like that here.

Learning how to make the time helpful (not necessarily useful, but at least somewhat helpful) to the client is again helpful with all age groups and work environments. I’ve had sessions focused on asking parents for a pet, playing games, being calm in a storm, being an adult who validates that the lack of control teens have over their lives is shitty, and (most often) figuring out how to get adults to listen to what their teen says.

3. I don’t wanna fuck up.

Of course you don’t. This is true for all clients but teens are more likely to tell you when they feel you are fucking up. We know this time in their lives is important, impactful. The fear of fucking up is so very valid.

What I have found is that you will fuck up, you’ll say the “wrong” thing, you’ll use the ineffective modality. Accept that right away so you can begin to prepare for repair.

One of the most powerful experiences I’ve seen when working with teens is an adult, including me, take ownerships of fuck ups and apologize. Becoming the model for how the teen can engage with others and expect to be engaged with by others is powerful and needed.

Of course there are more reasons people have for not wanting to work with teens but these are the main ones I hear most often.

There are others yet who work with teens because they recognize the importance but struggle to know how to do so well. They feel pressure from the teen’s adults, pressure from the mandatory reporting laws, pressure from the immense power adults have over teens in general. I view this as even more reason we need trained, liberationist therapists who work with teens. Especially Black, Brown, and Asian teens, queer teens, neurodivergent teens, fat teens, and disabled teens.

Teen Tips

So, let’s talk about some teen tips, things you can do to strengthen your capacity to work with teens.

Virtual vs in person.

Many people find it easier to work with teens in person. You have a lot more options to pivot from traditional talk therapy which isn’t always the most effective. Things like art, board games, movement activities, etc. can feel easier in person. It can also feel as if teens are more engaged in person, not as distracted as if they are in their own rooms. There is also of course the fact that it’s harder for others in the house to overhear when in your office.

When possible, meeting in person might be preferable. When not possible, here are some tips:

Have a variety of online games and activities (there are online sandtrays, player v player games, and even phone games you and your teen might find enjoyable.
Don’t be afraid to share your screen (and if possible in your EHR allow them to as well), look up the shows they are describing, the characters of their favorite books, pull them up and discuss with visuals. This helps them stay engaged and shows them you’re engaged as well
Ask the teen (and parent) ahead of time to get any materials you might want (such as art materials, movement tools, etc)
Ask parents (and other household members if possible) to commit to wearing headphones or listening to music or tv or podcasts out loud, ask the family to invest in a sound machine to place outside of the door of the teen, or even if the teen could sit in the car during session for privacy
If possible it can help connection to begin meeting in person and move to virtual after some rapport is built if coming in person is a hardship on the family or scheduling

2. Parents, caregivers, and adults (oh my).

I know, this is what you’re really hear for (and I thank you for reading through the rest to get here). As I said, this is by far and away the most reported reason I see people saying they don’t work with teens. Adults who force their kids into therapy, who want their teen to be “fixed”. These adults have unrealistic expectations of their teen and of you, the therapist. Or, adults who refuse to go to therapy themselves even though we can see how the teen’s behavior is a response to the adults’. Adults who hold on too tight, who release too early, adults adults adults.

It’s true, working with teens inherently means working with adults. Here are some tips to get you through that hardship:

Set boundaries early and often. Before you begin working with a teen, identify what role (in general) you’re open to their adults playing. Know that it won’t be possible for you to hold every family to the same standard but some general outlines. For example, based on age, I have a frequency with which I expect to meet with a teen’s adults, I have limits to how often and deep I engage with adults outside of session, and I make clear that if adults have things they want their teen to work on I will expect them to communicate that during a shared session with the teen and be open to the teen’s responses.
Remember that it’s not either or, it’s both and. Aligning with your client (the teen) does not mean aligning against the adult. I see folks get tripped up on this often, they think that they must either align with their client OR their client’s adult. This get’s sticky fast. You can recognize an adults challenges or strengths without abandoning your client. When a teen’s adult feels heard by you they’re more likely to continue treatment and even engage in the treatment to the degree you deep appropriate.

Be realistic. The adult has the power over your client until that client is 18 (or emancipated) at EARLIEST. Denying this gets you nowhere. Be realistic when you do your documentation (write as if the parent will read it), be realistic when you encourage your client’s to advocate for themselves, be realistic when you conceptualize progress and possibility before and after 18. We’re not going for negativity here, we’re going for realism.

The adults are more afraid of you than you are of them. Ok, not every time but for a lot of caregivers they’re running on fear, possibly shame and feeling incompetent, some level of frustration (at themselves, their kids, their circumstances, etc). It’s not about you. No, really it’s not about you. If you can remember that, it’s easier to hold some level of compassion for them (and remember point number two, you can hold compassion for them and compassion for their kid all at once).

3. They don’t want to be here.

It’s really hard to do consent and assent based treatment with someone who didn’t chose to be there. Teens dragged in by caregivers, apathetic at best pissed off (rightfully) at worst. These are real tough situations, and what’s harder is you know if you say no someone else will say yes. Will they be oriented to liberation psychology like you are? Are they going to understand and value neurodivergence, will they work toward as much autonomy as possible, least restrictive diagnosing? Will they pathologize “non-complience”? I’m telling yall, we need better teen therapists out there!

When a client doesn’t want to be seen for therapy there are a few things you can try, not to coerce them to comply but to at least make the time you’re sharing not actively harmful. Here are some tips:

Acknowledge the suck! Recognize and acknowledge and validate how fucking annoying it is to be required to go to therapy. How disempowering being told you’re required to try to engage in “personal growth” or whatever the fuck the adults think therapist is for truly is.
Try to support whatever goal the teen has that is truly their own. Want to convince your parent to get you a pet? Want to get more time out with your friends? Later curfew? Less oversight? Want to be done with therapy? Let’s work on it!
Recognize that offering a safe port in the storm is sometimes enough, don’t make them “dig deep” and do all the therapy shit. Use the time for them to tell you about their favorite videogame, hell play it with them if you can. Listen to their special interest, to their friend drama without trying to therapize them until they ask (if they ask) for that. Draw or color quietly. Listen to their favorite playlist through session, watch an episode of their favorite show. Be the adult who listens to their boundaries and limits and honors them.
Support the client in advocating for why therapy is not needed/helpful/effective at this time and what might be instead. This looks different for every teen but a few that spring to mind as possibilities are: more time with friends if social isolation is the issue, new videogames if mastery would be helpful, an agreement for the caregiver to go to therapy if the teen is expected to continue, coaching for executive functioning challenges, etc.
Support them with planning for termination after they turn 18 and how to access therapy again if they ever want to in the future. Sometimes teens will prefer to plan to see a therapist who didn’t know them as a teen or who has never been in contact with their adults, support them in learning how to identify a good fit therapist for them for any future interest or need.

I hope some of these tips make you feel more confident in working with teen clients, maybe even helps you consider doing so if you don’t currently.

We Gotta Talk About the Teens

Teen Tips

At the Center of Racial Communication Challenges