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«Nobody else can lead your life»: What adolescents need from therapists in change processes ff Facing a scary situation: Attend to the adolescent’s starting point The therapist triangle: Three paths to establishing trust The therapeutic process: Mutuality as a virtue The first therapy session was frightening: • They were nervous about who the therapist was, what was expected of them and what they should talk about. • Therapy was not their choice. Often a parent, teacher or doctor had taken the initiative to start therapy. This also meant that therapy initially was not about them and their needs. • The scary situation of starting therapy hindered their ability to engage in the therapeutic process and their motivation to attend the sessions. • Therapists had to prove them wrong in order to make the therapy process constructive, through gaining their trust and establishing a mutual therapeutic relationship. Three therapist qualities that helped establishing trust: • Be warm, invested and emotionally engaged. The adolescents needed their therapist to be kind and engaged, and sensed whether their therapist really cared about them through noticing the therapist’s reactions to what they were telling. • Offer live company and presence as a real human being. Therapists had to act naturally and be a human with a personality and a history like everyone else. It was relaxing to talk to someone who was “merely a fellow human being” in an open and sincere manner. • Have integrity as an adult and a professional. Therapists should be able to understand what adolescents go through without overdoing it or pretending to be adolescents themselves. They should also be competent: having a plan for the session, radiate wisdom and a professional safety. Two ways of establishing a mutual relationship: • Know the world of a teenager and get into their stories. Therapists had to know their entire life situation and get to know them truly: their history, dreams, hobbies, family, friends, and school situation. Simultaneously, therapists had to keep in mind the pressure related to appearance, getting good grades and being popular at school. • Have mutuality as a virtue and treat the adolescent as an equal. Therapy was regarded as a collaborative process in which the adolescents were equal partners in the therapeutic endeavor. Therapists could provide them with support, advice and help along the way, whilst keeping in mind that nobody else could lead their lives. Take home message • A good therapeutic relationship is vital for the success of adolescent psychotherapy. • Attending therapy is a scary situation for adolescents, and they need to overcome their initial apprehension about psychotherapy to engage therapeutically. • Therapist can gain their trust through being radically caring, self-disclose reasonably and by using their professional knowledge carefully. • Therapist can establish a mutual relationship through truly getting to know their patient and treating the adolescent as an equal collaborator. • Future studies are needed to validate these findings. References [1] Merikangas, K.R., et al., Lifetime Prevalence of Mental Disorders in U.S. Adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 2010. 49(10): p. 980-989. [2] Fonagy, P., et al., What works for whom? A critical review of treatments for children and adolescents. 2015, New York & London: The Guilford Press. [3] Lambert, M.J., The Efficacy and Effectiveness of Psychotherapy, in Bergin and Garfield´s Handbook of Psychotherapy and Behavior Change, M.J. Lambert, Editor. 2013, John Wiley & Sons: New Jersey. p. 169-218. [4] Warren, J.S., et al., Youth Psychotherapy Change Trajectories and Outcomes in Usual Care: Community Mental Health Versus Managed Care Settings. Journal of Consulting and Clinical Psychology, 2010. 78(2): p. 144-155. [5] de Haan, A.M., et al., A meta-analytic review on treatment dropout in child and adolescent outpatient mental health care. Clinical Psychology Review, 2013. 33: p. 698-711. Contact information Corresponding author: Kristina O. Lavik, Department of General Psychiatry, District General Hospital of Førde, Førde, Norway, [email protected] Reference: Lavik, K.O., Veseth, M., Frøysa, H., Binder, P. E. & Moltu, C. (2018). «Nobody else can lead your life»: What adolescents need from therapists in change processes. Journal of Counselling and Psychotherapy Research, doi: 10.1002/capr.12166 Quote “Well, I think of my therapist and I as a team, almost. But when it comes to it, it’s me who has to live with my experiences. She can help me. She can support me by learning me to… to live and find ways of coping with life. But, when it comes to it, it is my life. And no one can live it for me. So… they are important supportive persons. You’re the boss and captain of the team, but the therapist is there, having your back.” Introduction A startling 22 % of young people have a psychiatric disorder causing significant functional impairment [1]. Although RCT studies show promising results regarding the effectiveness of psychological treatments for many mental health conditions in adolescence [2], small effect sizes are found in studies from community-based usual care settings [3] and a staggering as 20 % of young patients leave therapy worse off than when they first started [4]. Moreover, a recent meta-analysis shows that dropout ranges from 16 % to surprisingly 72 % in outpatient services [5], numbers that are consistent with other studies. Aim To gain in-depth first-person knowledge about what adolescents need from their therapists to engage therapeutically and benefit from treatment. Methods A total of 22 adolescents aged 14-19 years participated in qualitative semi-structured focus groups or individual interviews, of their own choosing. 16 were girls (mean age 16, SD 1.4), and six were boys (mean age 17, SD 1.5), all Norwegians by birth, struggling with anxiety, depression, relational trauma and suicidal ideation. A systematic step- wise consensual qualitative research framework for team based-analysis was used for analyzing the data.
