Summary: We create agency and voice for teens in mental health treatment by listening actively until we understand the needs, wants, and goals teens have for treatment, while carefully calibrating those goals with the needs, wants, and goals of parents and other family members.
Key Points:
- While it’s essential for teens to take ownership, establish agency, and know their voice matters during the mental health treatment process, it’s also essential to understand that for a teen under 18 years old:
Parents do not need permission to decide their minor teen or teens need psychiatric care.
- When treating teens, we make it clear their treatment progress is the primary goal, but treatment will always involve parents, and may involve other family members when necessary.
- During intake and assessment, we spend time with parents and teens both separately and together, in order to learn as much as possible about the family dynamic.
- During intake and assessment, we determine whether the parent/parents may benefit from treatment, separate from their teen/teens.
- Treatment plans, which include types of treatment, long- and short-term goals, and components unique to each patient, are the result of a collaborative process that begins upon first contact.
Teen Mental Health: A Family Problem
Here are comments we hear from a large percentage of teens reluctant to engage in treatment:
I’m tired of being blamed for everything in this family.
I’m tired of being dragged around to all these different doctors
My parents would never do therapy because they think I’m the problem and nothing they do has anything to do with what’s going on.
We hear that last comment quite often.
In fact, in a recent clinical review session, one of our psychiatrists recently shared a conversation they had with a teen entering one of our treatment programs. During their talk, our psychiatrist indicated the cycle of behavior the teen was in with her mom would require them both to do work in individual therapy as well as work on their relationship during family therapy.
The teen replied, “She’ll never do therapy.”
When our clinician answered, “Believe it or not, we already discussed it and she said she would. She even knows she needs to. So, I’m helping her find a therapist. It won’t happen overnight, and it won’t be easy, but that’s the plan. How does that sound?”
The teen gave our psychiatrist a cautious, curious look of bewilderment, like she’d just stepped through the looking glass to a new world she didn’t recognize. In that case, for that teen, knowing her mom was willing to accept some responsibility and participate in treatment made all the difference.
That’s what can happen when a mental health professional validates a teen and recognizes that teen mental health problems are, in most cases, family problems, and that in order to resolve them, both parents and teens need to commit to doing the work of treatment and recovery.
But how do we get to the place where teens in mental health treatment and parents of those teens share the commitment, take accountability, and agree to work together toward a common goal?
Teens in Mental Health Treatment: Agency and Voice from the Beginning
We’ll circle back for a moment to the first bullet point in our summary.
When a teen expresses reluctance to engage in treatment or refuses treatment outright, highlighting the importance of their voice and agency in the treatment process can be problematic. In cases where family dynamics are complex and overwrought, refusing to participate may feel empowering for a teen who feels trapped in a painful cycle of conflict and simply needs their feelings noticed before agreeing to anything.
In those cases, treatment refusal is not the empowerment we’d prefer, but for a teen who feels powerless, it may be one of the only things they feel they have power over. Therefore, they apply what power they do have, and refuse treatment.
It’s not helpful, but it’s logical.
To ensure teens feel seen, heard, and empowered, we take several proactive steps during our initial meetings. We’ll review how the process works for outpatient treatment, intensive outpatient programs (IOP), and partial hospitalization programs (PHP).
Families and Teen Mental Health Treatment: Procedures That Promote Participation
We’ll start with general procedures that apply to patients seeking care at the outpatient, intensive outpatient (IOP), or partial hospitalization (PHP) level of care.
Note: for patients entering IOP or PHP programs, we schedule goal review sessions with teens, parents, and members of the treatment team together, whereas for patients entering outpatient care, goal review sessions may occur in separate meetings due to time and logistical constraints.
In all our programs, the individual therapist who supports the teen patient during one-on-one therapy is a different therapist than the family therapist that supports the family during family therapy sessions. This policy helps the teen know someone is there to hear their side, with no interruption, correction, or editorializing from their parents.
Having one person dedicated to listening to and helping them is critical for teens seeking a voice in treatment.
Another general procedure we follow that has an impact on teens in mental health treatment is that our clinicians avoid gathering data from parents about the overall situation in front of the teens, particularly when the questions could be embarrassing and parent answers could feel judgmental, objectifying, and/or reductionist.
Here are additional policies and procedures that promote agency and voice for teens in mental health treatment.
- All initial diagnostic evaluations include individual time with teens, separate from parents, which ensures we hear and understand their perspective directly from them.
- We share out initial treatment recommendations with teens and parents together – at the same time – to elicit questions, clarify goals and expectations, and collaborate on a shared treatment plan that the teen has a voice in creating.
- When the level of conflict in a family is high, the treatment plans recommends a separate therapist to address family interactions, relationships, and dynamics.
- In high conflict divorce situations, we work to avoid teens witnessing their parents squabble in the treatment setting.
- We may recommend scheduling separate case management meetings for parents in high conflict divorce situations, too.
- If parents don’t align on the interests of the child, or can’t agree on the contents of the treatment plan, we recommend parental mediation work, and refer parents to a third-party mediator.
We’ve adopted these policies and procedures over the years because they work. When we say teen mental health is a family problem, what we mean is not that the teen’s problem causes problems for everyone else – although in some cases that may be true – what we mean is that a teen mental health problem is most likely created by the family as a whole, and, therefore, can best be resolved by supporting the whole family.
Where Can We Improve?
We can improve by ensuring that everyone involved – parents, teens, caregivers, and in some cases, siblings – about our expectations around family participation. To be clear, at BACA:
We expect families to participate.
By families we mean parents, any primary caregivers/guardians, and siblings if applicable. And by parent participation, here’s what we don’t mean:
Sessions where providers and parents spend the entire time reciting the teen’s perceived faults, shortcomings, and problems to the teen.
That never helps.
What we mean by parent participation – and we want teens to know this – is that if we determine the parents engage in behavior that exacerbates or contributes to family conflict and/or plays a role in triggering symptoms in the teen, then we expect the parents to work to understand, reduce, or eliminate that behavior, which may involve them participating in individual with a therapist outside of BACA, in addition to the work they do in family therapy with their teen.
When we tell teens we evaluate parent behavior, too, and recognize how it may contribute to the situation the family is seeking treatment for, we often see the look of wonder and near-bewilderment on their faces we describe above. We nearly always imagine seeing this thought bubble over their head:
Finally! Someone gets this is not all on me!
Teens who experience this often fully commit to treatment for the first time. In some cases, this happens after months or even years of being dragged from one doctor to another or being blamed for literally everything bad in the family. When they hear that their voice matters, that they’re not the villain in the situation, and that everyone is on board – and willing to do their part – something changes, and the journey toward healing can begin.
Teen Mental Health Treatment: Collaborative Effort, Mutual Accountability, Planned Flexibility
When we meet a family with a teen who needs mental health support, our goal is to learn as much as we can about the teen and everything in their life that may contribute to the need for mental health treatment and support. That means we learn about their family, their relationship with their parents, grandparents, siblings, and any other important people in their lives.
When we identify behaviors, patterns, or situations that inhibit rather than promote health, we work to resolve those behaviors, patterns, and situations in a way that effectively reverses them, and replaces them with behaviors, patterns and situations that promote rather than inhibit health.
That process takes work, but it’s worth the effort. Each participating family member operating within an effective treatment plan will know what’s expected of them, understand they have a role to play in restoring family harmony, and be aware that as situations arise – whether successes or setbacks – they may need to reassess, readjust, and recommit to a revised plan with the same goal: supporting the teen in treatment and guiding the family back to a place of balance.
