Teens come to psychotherapy for many reasons. Sometimes, and less often, because of their own interest for self-improvement, and most often at the prompting of their parents or a loved one. Psychotherapy is usually sought when parents notice a significant change in their child. Maybe their teen daughter is developing some concerning eating habits or their son refuses to get out of bed to attend school each morning. Teens go through a multitude of external pressures. Pair the external pressures with a newly forming identity, rocky self-esteem and huge loads of self-pressure, the adolescent years are a challenging time for most teens.
Starting psychotherapy can be overwhelming for a teen. One of the best ways that parents can help their teen feel more prepared to begin psychotherapy, is for the parents themselves to gain an understanding of what to expect from the psychotherapy process. Talking to your teen before their first appointment and helping them understand what to expect, can help reduce their anxiety about starting psychotherapy.
Following below is a helpful outline for parents that covers what to expect from the treatment process. The outline covers the assessment phase, what privacy and confidentiality will look like, what psychotherapy sessions will involve and how to know when therapy has been effective.
How does therapy work?
There will be four phases to your child’s psychotherapy.
The first phase involves an intake assessment phase with parents. Usually one or both parents will have the opportunity to speak to their child’s psychotherapist before counselling begins, via telephone or e-mail, or at the beginning of their child’s first assessment session. A parent’s perspective on their child’s current presenting issues and life history are important areas to inform the psychotherapist on. With younger teens, there is often a full assessment interview that is conducted in person with both parents. Most often, a parent will provide preliminary information to the therapist, then a first appointment is set, both parents are welcome to attend the first session. If parents attend the first session, usually the appointment begins with parents sharing their perspective on the presenting issues and providing their feedback on what they are hoping psychotherapy will help with. The second half of the session will involve your child and the therapist meeting one-on-one. After the assessment phase, your therapist will have a good overview of what symptoms your child has been experiencing and the goals for therapy will be set.
Special consideration for the assessment session: Parental Involvement and Privacy
An important part of the assessment phase is determining what parental involvement will look like and how much communication parents will have directly with the therapist.
Each family will uniquely decide on their degree of comfort with parental involvement. At the first session, the family will decide on how involved parents will be in therapy. Confidentiality and session privacy policies will be discussed by the therapist. Both the teen and the parents will have the opportunity to communicate what they expect in terms of family involvement. Factors to consider in decision making are the age of the child, seriousness of the issues, relationship dynamics and communication styles of family members. Psychotherapy works best when everyone comes together to agree on what information will or will not be shared with family members. Creating a trusting and safe environment where your child can feel that they can freely share what is on their mind, is essential to the success of therapy.
Often times parents involvement in therapy can prove helpful. Parents can be great assets to psychotherapy, by attending family sessions, learning more closely about how to support their child at home and also taking feedback from the Psychotherapist, who can provide tips to help parents improve communication and relationships at home.
Sometimes though, parents over-involvement can impact the course of therapy in a not so positive way. A parent’s unrealistic expectations can take therapy off course. It can be hard for parents to trust a new psychotherapist and trust the psychotherapist’s treatment approach. If a parent doesn’t trust that the psychotherapist is on the right track, or if the parent urges the therapist to share more than their child is ready to share, progress can be halted. In some cases, parents will undermine the therapy process by emailing the psychotherapist without the teens knowledge or by putting pressure on the therapist to influence a change in their teen before the teen is ready. Teens are more likely to share in their own time, rather than under pressure. Therapy is a slow and delicate process, and moving at your child’s pace and accepting their need for privacy is important.
There are three different options for teens and families related to confidentiality:
Full communication between parents, psychotherapist and teen: Suitable if the teen is close with parents and trusts the psychotherapist to give updates as needed or as requested by parents. The teen has no concerns about parents being aware of what is discussed in therapy. Parents are welcome to attend sessions as needed and also are able to e-mail the psychotherapist with questions that arise at home in between sessions.
Partial communication between parents, psychotherapist and teen: Suitable if the teen wants some areas of psychotherapy to remain private. The teen is comfortable with the psychotherapist providing progress updates and releasing certain private information, if it is agreed to by the teen first. The teen is less comfortable with parents e-mailing the psychotherapist directly with questions and would like to be aware of e-mails first, before the therapist responds.
Minimal communication between parents, psychotherapist and teen: Suitable if the teen would like full privacy with the psychotherapist. Parents are comfortable with the teen having a private space to explore their presenting issues. Parents can only receive updates on progress as agreed to in advance by the teen. The teen prefers that parents do not contact the psychotherapist without their knowledge. Typically parents are more comfortable with this agreement when the teen is older than 16 years of age.
Creating a plan with the psychotherapist related to confidentiality from one of the three options listed above will increase the likelihood of your child moving forward well through psychotherapy.
It is important to note that Canadian laws related to privacy indicate that should a teen be at harm to themselves, then confidentiality agreements may need to be overridden in order to protect the safety of the teen. Typically, if the psychotherapist has concerns for the teen’s safety the therapist will first communicate this to the teen and develop a plan together with the teen to involved family to ensure the teen is safe. The psychotherapist has a legal duty to report if an individual is being harmed by another health practitioner or if a child is experiencing abuse. Client files are kept confidential unless subpoenaed by a court of law.
Next, your child will begin psychotherapy treatment. They will spend the majority of their time one on one with their psychotherapist. Working on their therapeutic goals with their therapist in a manner that is both supportive and hands-on. Your child will feel heard and understood, which will help them make sense of what is going on for them. Once the psychotherapist and your child have a good understanding of the reasons behind their symptoms, they will begin to develop practical coping strategies for at-home practice. Your child will learn about how the way that they think about themselves and the world, influences the way that they feel and behave. Creating new ways of thinking and behaving will improve the way way your child feels overall.
Each psychotherapy session typically involves the following format: Check-ins on how the past week has been. Then reviewing the assigned at home practice homework from last week. Exploring if their were any roadblocks to practicing skills at home is reviewed. Then settling in to today’s session focus – which will be a combination of what the therapist has prepared for new coping strategies based on the overall treatment goals and also what your child is interested in discussing that week. Then therapy wraps up by developing ideas for at-home practice or review. The psychotherapist will then let the teen know if there are some areas today that will be important or helpful to update parents on – either with the parent’s coming in to attend the end of today’s session or with an e-mail update following the session by the therapist.
Continual Assessment of Progress
Typically, there will be four sessions to start. After the fourth session, the psychotherapist will have a thorough assessment completed for your child’s presenting issues and have started to teach coping strategies. At this time, the psychotherapist will evaluate how your child is progressing within the treatment goals. After four sessions, your psychotherapist will have a good sense of what the course of psychotherapy will likely look like. Sessions will either continue weekly sessions or if good progress has been made so far, sessions will begin to be spaced out to bi-weekly.
Parents will be continually involved in therapy. Attending sessions as needed and receiving updates on progress and learning about new coping strategies that will be practiced at home that week. Parents can help their child implement change more quickly by learning about the coping strategies they have developed with their psychotherapist and supporting at home practice. The therapist may also recommend workbooks for your teen or parenting books for parents, to facilitate greater understanding of the mental health concerns your child is experiencing.
Therapy will end when your child’s presenting issues have been improved and their therapy goals have been achieved. Sometimes teens or parents can choose to end therapy early, if they aren’t yet ready to create change in their life or if there isn’t a good fit with the psychotherapist. If a parent has concerns or questions about treatment or progress, they will be welcome to share with the psychotherapist. When psychotherapy is working well for your child, you will notice a shift in their initial symptoms, an overall better at home connection with your child, improved mood and less school related incidents. The family and psychotherapist will agree together when significant progress has been made and your child can take a break from psychotherapy. Your child will always be welcome to return to psychotherapy for check-in appointments or should a new issue present itself.
Psychotherapy can be a life-changing journey for your teen and the effect on family dynamics can be wonderful. Learning about what to expect from psychotherapy will help prepare both teens and families for success in the path that lays ahead.
Article written by Cassandra Petrella, MA, Registered Psychotherapist & Clinical Director, Senta Counselling Services