Dear Therapist:

Thank you for your weekly column. I am involved in a drop-in program that helps "kids at risk." I am wondering on your opinion on sending younger teenagers with behavior issues to therapy. We have sent them in the past - with limited results. I'm not sure if most of them are really ready for any type of serious therapy. Wouldn't our time and energy be best invested in getting them a mentor and offering other types of support? Sometimes all the therapist winds up being is that same listening ear they would get from a big-brother anyways. Obviously, every case is different but what do you think about waiting on therapy for a teen until they settle down and are old enough to really take to it. I am hoping that you could share your thoughts and personal experiences on this matter. Thank you. 

Response:

Your question relates to “kids at risk.” I don’t think that most people understand the term. I certainly don’t. What specifically is the risk for the kids to whom you refer? Without going into details, there are many possible risks, ranging from religious factors, to lifestyle choices, to risky behavior. Therapy (as well as other interventions) would depend on each child’s needs and issues.

Each child has a unique set of circumstances that have placed them in the “at risk” category. For some, a sense of constriction or autocracy may have led to rebellion. For others, poor performance in school may have caused low self-esteem. For yet others, abuse or other trauma could lead down a path of destruction. Some kids have undiagnosed or untreated ADHD, others have depressive or anxiety disorders or other mental health issues. There are so many possible factors and combinations of factors that it is impossible to identify a general course of action for “kids at risk.”

In your experience, sending kids to therapists has yielded limited results. Is this based on your observations or on the kids’ perspectives? If the latter, did their perspectives change once they were adults?

You describe your program as drop-in. Does this mean that your exposure to each kid is limited to small periods of time? Therapy does not always yield quick results. This is especially true with adolescents. Additionally, each child requires different interventions based on their issues and needs. Some can work on their issues almost immediately, while others need time to build a trusting relationship with the therapist.

While one teenager may gain little or nothing from therapy, for another it can be a lifesaver. Some kids can use the therapy process as a crutch and diagnoses as excuses for their behavior. This, however, does not necessarily mean that they shouldn’t be in therapy. In fact, many times these negative reactions to therapy are only an extension of their tendency to react similarly in many situations. A good therapist can help them to recognize and challenge this practice.

However, your point is well taken. In many cases, teenagers who don’t fit within the box are labeled as “kids at risk.” Sometimes this is overt, while at other times it is just the sense that they get from parents, teacher, friends, or the community as a whole. Sometimes it is this sense (real or imagined) that is the basis of their being at risk in the first place. For some kids, being in therapy can reinforce the notion that there is something wrong with them, just as going to a “kids at risk” program might. Does this mean that these should be discontinued? The answer would be very individualized. 

If your experience has been with therapists who simply function as a listening ear for their teenage clients, they may not be the proper therapists for the kids in your program. A proper therapist would theoretically be able to build a rapport with the client to the point where the client would be open to suggestions and to challenging automatic thoughts, perceptions, and behaviors.

Are teenagers, in general, ready for this type of therapy? Again the answer is very individualized. However, it is the therapist’s job to help clients identify their issues and help them to change. Any therapist who, over a significant period of time, is simply a listening ear is likely not doing much good. Often, these are the therapists who buy into their client’s tendency to blame others or their situation for their behaviors.

Rather than trying to decide whether teenagers (general) should see therapists (general), the question should be, “Should this particular teenager see a therapist, and if so which therapist?”

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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