Saturday July 23rd 2016

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How to help my child with addiction

Even teens are children.

And when your child needs help with an alcohol or drug problem, you’ll probably need professional help. So, what can you do to help a teenager struggling with substance abuse or mental health issues? How can you encourage them to get help…and what should you be looking for?

Here, we take a look at what parents should know about helping teens begin the path to addiction recovery. What should you look for in a therapist, for example? What kinds of qualities best engage teens in the therapeutic process? Then, we invite your questions or stories at the end. In fact, we try to respond to all questions personally and promptly.

What Parents Should Know About Engaging and Motivating Teens in Counseling

If you are a parent with a child who has been diagnosed with a mental health and/or substance use disorder, you are likely interested in finding a good therapist or counseling program with whom your child will feel engaged and connected. Good therapists know that building a therapeutic alliance (a good working relationship between therapist and patient) with teens can sometimes be challenging but it is important to develop early in treatment. The literature on engaging teens in treatment has focused on three main areas:

1. Identifying therapist behaviors that get in the way of therapeutic relationship formation
2. Identifying relationship enhancing practices
3. The role of parents

Qualities of a good counselor for teens

As a parent you may have heard of such a thing as “evidence based treatment”, which means therapy or treatment models that have been carefully and scientifically tested, usually through clinical trial research. These therapies are usually cited as being effective if delivered in the form in which they were studied and developed.

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But therapists have to be careful, as rigidly adhering to manuals despite their proven effectiveness could undermine the basis of forming an alliance, which is to tailor the therapeutic relationship to the individual needs and concerns of the teen. The strict implementation of manuals can have implications for teens who may be less willing to develop an intimate relationship with a therapist. They may decline active participation in therapy that they perceive as not collaborative, or that adheres rigidly to an agenda rather than addressing their own issues as they arise.

Therapists who present themselves as overly formal and didactic without acknowledging and/or showing understanding of the emotions and concerns that the teen raises have much greater difficulty engaging teens in therapy than therapists who are warm, open and demonstrate that they can be flexible and yet responsive.

The Secret to Achieving Therapeutic Alliance

Demonstrating empathy, warmth, trustfulness, positive regard, acceptance and genuineness has been linked to positive relationships with youth, increased participation in the therapeutic process, and improvement in clinical symptoms. Many consider the therapeutic alliance as the most important “active ingredient” in any therapy and research supports this notion. So it is quite important even for manual guided therapy.

Some ways that might be helpful for engaging teens are:

  • Using inviting and open ended questions so that teenteens can share their experiences, views, and concerns is more successful in engaging teens than using closed ended questions or appearing to be using a check-list of questions based on an agenda. A well studied style for achieving this is the motivational interviewing approach. Treating the teen as an equal and inviting him or her into a collaborative conversation as opposed to demanding answers to questions is important.
  • Spending time towards understanding his/her experiences, the underlying explanatory model he/she uses for understanding their problem or referral issues and work collaboratively to formulate treatment goals.
  • It is helpful when the therapist bridges his/her view of clinical issues with the teen’s views and seeks input from the teen on acceptability of the treatment plan and markers for improvement.
  • A teen-empowered environment is enhanced when therapists present themselves as allies, demonstrate empathy, validation, and nonjudgmental reflective and mindful listening in response to the topics raised by the teen, and reinforce progressive participation in session with specific and encouraging statements.
  • Actively responding to teen topics and maintaining confidentiality also allows therapists to demonstrate their role as a committed ally and to give teens some authority over their treatment. For this reason, teens are given the opportunity to suggest topics and situations which can be addressed with the strategies presented in the therapy.
  • Additionally, providing clear rationales for treatment decisions and activities in developmentally appropriate language demonstrates respect for teens as active participants in treatment and helps to establish therapist credibility, which increases the likelihood of teen participation in treatment.

Alliance with parents and other caretakers

Teens usually do not refer themselves for services, so forming a therapeutic alliance with you – the parent or guardian – is important. Parents are often responsible for facilitating treatment by:

  • scheduling appointments
  • transporting the teen
  • consenting to treatment
  • providing clinically-relevant information about the teen’s experiences and behavior
  • implementing therapeutic assignments that serve to modify the teen’s environment

In fact, the alliance with caretakers has been found to relate to parent/family participation in therapy, which is in turn related to teen improvement (Karver et al. 2006). It is important to create an environment of open discussion with parents and other family members during intake sessions.

This can be done by utilizing a semi-structured format in which family members are welcome to share their experiences and concerns as they come up in the assessment. It is important for therapists to be sensitive to family beliefs and values and to show interest when parents share information during discussions.

Treating teens and parents at the same time

In order for the therapist to engage both parents and the teen simultaneously, it may be essential that the therapist find ways to bridge the gap between parent and teen perspectives. The therapist can identify points of agreement to encourage discussion, enlist parents and teens as collaborative team members, and help identify mutually acceptable treatment goals and plans. As usual, clear policies about the limits of confidentiality are discussed with the teen and family. Usually, confidentiality is maintained for what the teen shares in therapy, with the exception of situations of risk for physical harm, abuse of a minor, suicidal or homicidal ideation.

Employing Motivational Interviewing

Motivational interviewing (MI) has been shown to be effective at reducing alcohol and substance use in teens with an initial low motivation to change it is not possible to address the full scope of MI in this abbreviated format, some of the main principles include:

Taking an empathetic, nonjudgmental stance and listening reflectively. This involves attempting to understand a teenager’s perspectives and helping them feel understood, so that they can be more open and honest with others

Identifying how the teen’s current behavior may affect their goals. This involves working with teens to identify personally meaningful goals, and helping them to evaluate whether what they are doing now will interfere with where they want to be in the future.

Rolling with resistance. Rather than arguing with teens when they hit a roadblock, help them develop their own solutions to the problems that they have identified.

Supporting self-efficacy for change. The belief that change is possible is an important motivator for successful change. Help teens to be hopeful and confident about their ability to impact their own future in a positive way.

Leaving the door open

When teens want to terminate treatment, make sure they know that they can come back at any time. Experienced treatment providers know that often it takes awhile for a teen to start coming in regularly and to fully commit.

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Reference Sources: A great website that helps young people to start thinking about how to talk about mental health and addiction through peer based social media is ok2talk
Other Reference Sources: Karver M. S., Handelsman J. B., Fields S., Bickman L. (2006). Meta-analysis of therapeutic relationship variables in youth and family therapy: the evidence for different relationship variables in the child and teen treatment outcome literature. Clin. Psychol. Rev. 26, 50.6510.1016/

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About Dr. Lisa Fortuna, MD, MPH

Lisa R. Fortuna, MD, is board-certified in child and adolescent psychiatry and in addiction medicine, with over fifteen years of clinical experience with children, adolescents, and families. She is currently faculty at Boston University School of Medicine and medical director of Child and Adolescent Psychiatry at Boston Medical Center. She has published highly cited articles in the areas of post-traumatic stress disorder (PTSD), adolescent substance abuse, and Latino and immigrant mental health. She is the author of (with Zayda Vallejo M. Litt), Treating Co-Occurring PTSD and Addiction: Mindfulness Based Cognitive Therapy for Adolescents with Trauma and Substance Use Disorders (New Harbinger, 2015).

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