2 FIRST MEETING Getting Teens to Talk With adolescents, sometimes the shortest distance between two points is a circle. Copyright © 2005. Guilford Publications. All rights reserved. D ecades ago, I did my internship at an urban teaching hospital. We spent a great deal of time learning how to do an initial interview. We were taught to start with the presenting problem and then go through a standard checklist of questions that helped us understand the “mental status” of the patient. One of the patients assigned to me was a very young man, Tom, who had been run over by a car during a psychotic episode. He woke up in the hospital gravely, although temporarily, injured. After Tom went through understandable rage at his bad luck, he was helped along in his sixmonth struggle by the sudden appearance of Deborah, a new patient on the ward. Tom and Deborah developed a relationship, and after a weekend pass spent together, they suddenly decided to marry. The entire ward was both thrilled and shocked that after this short time they would make such a big move. No amount of discussion with his fellow wardmates (who were quite vocal on the matter), the staff, and certainly me, the lowly intern, seemed to lead to any insight on either of their parts. I called in my supervisor, Aryeh Anavi, and asked him to sit with us as Tom and Deborah discussed their future plans. For a few minutes I fumbled around, posing one lame question after another: 30 Taffel, R. (2005). Breaking through to teens : Psychotherapy for the new adolescence. Retrieved from http://ebookcentral.proquest.com Created from touromain-ebooks on 2020-02-17 19:14:25. 2. First Meeting 31 Copyright © 2005. Guilford Publications. All rights reserved. “How do you feel about your relationship?”, “What do you think the reasons are you’ve been able to find each other now?”, “How do your families feel?” and so on. Aryeh, with his usual impatience, broke in and took an entirely different tack, which went something like this: “Tom, when Deborah’s birthday comes around, what do you think her favorite present might be? Something that she’d really treasure.” Tom was taken aback by this question about nitty-gritty “real life.” He stumbled around a bit, and said, “Gee, honey, I don’t really know. What would you like?” Deborah turned to him and said, “Anyone who knows me realizes that I love music.” Not stopping, Aryeh then turned to Deborah and asked her, “Well, I heard Tom’s been making a lot of headway in his recovery, and I wonder what some of the dinners are that you might plan for him. What is his favorite dish?” Deborah thought for a moment and responded, “Oh, lamb chops. I know that’s what he loves.” Tom looked and her and said lovingly, but with some disappointment, “No, it’s really chicken.” There was a long pause. Aryeh then said, “So, what is it that the two of you really love to do together? What interests do you have in common?” Neither was able to correctly identify the other’s particular interests. A quiet descended on the room until Tom said, “Maybe we’re rushing into this too quickly. We know our problems, but maybe we need to know more about each other’s everyday stuff before we get married. I guess this is what everyone has been trying to say.” Everyday Matters I never forgot Tom’s comment or the ease with which Aryeh had gotten this young adult and his girlfriend to open up, without ever asking a single question that seemed to focus on the traditional problem-centered inquiry. I was also struck by the fact that here was a young man who was known for being a very private person, one who had previously been impenetrable by even the best clinicians on the ward. These early lessons in one’s training—part awe, Taffel, R. (2005). Breaking through to teens : Psychotherapy for the new adolescence. Retrieved from http://ebookcentral.proquest.com Created from touromain-ebooks on 2020-02-17 19:14:25. 32 BREAKING THROUGH TO TEENS part shame—often hold for a long time. Years later, as I struggled with the clients I met in our bustling emergency clinic in the heart of Brooklyn, I often thought of Aryeh’s modest and highly effective method of getting young people to be straightforward. Ask kids to talk about things that really matter to them. Copyright © 2005. Guilford Publications. All rights reserved. * * * Many hundreds of clients and several decades later it became clear to me that some of the reluctance to talk on the part of adolescents had to do with my traditional approach. Times had changed; the kids I was now seeing did not have such specific problems. They were kids who had many behavioral or life issues more often than a single specific neurotic or borderline diagnosis. But, just as important, teens had become therapy-savvy. Whereas in the past I often faced clumsily mute, noncompliant clients, now, much more than not, kids were seemingly cooperative, glib, and even friendly to me. Yet as the interviews wore on, I realized that I was finding out absolutely nothing “personal” about their lives. Matt, for example, was referred to me because he had been kicked out of several schools for not going to classes or doing his work and was on the verge of being suspended from yet another school. Matt’s problems were typical of the changes I had noticed over the past two decades. He was a good-looking, bright young boy. He knew how to speak with sophistication about almost any topic and, on the surface at least, was willing to answer any questions put his way. The problem everyone—guidance counselors, psychologists, church leaders—had with Matt was that during an apparently successful give-and-take he revealed very little about his private thoughts, what his life was about, what could have motivated him to be so disengaged at school. Somewhere around this time I made a basic shift. I realized that if we are going to understand adolescents, we need to adapt those first crucial interviews to how kids actually think today. Remember, today’s teens are used to “climate-controlling” their emotional environment, to have things the way they want. The kiddie culture endlessly preaches that what counts is how they feel; the culture teaches them to be glib, but not necessarily expressive; the Taffel, R. (2005). Breaking through to teens : Psychotherapy for the new adolescence. Retrieved from http://ebookcentral.proquest.com Created from touromain-ebooks on 2020-02-17 19:14:25. 2. First Meeting 33 culture teaches them to regulate situations so they feel comfortable. Taking all this into account, it became clear that Aryeh “got” a truth, especially applicable to adolescents today: We cannot be predictable, traditional, problem-oriented “shrinks.” We cannot be the classic child professional most kids have seen so many times in the pop culture, have learned to take as a joke, and parry with so skillfully. We need alternative ways to get kids to open up when we first meet them. Copyright © 2005. Guilford Publications. All rights reserved. Interests, Not Problems Regardless of a teen’s or preteen’s presenting problem, I immediately start our first meeting by inquiring about his or her interests in life. I want to lower the level of a teenager’s discomfort while paradoxically throwing him or her off the expectation that this will be yet another entirely predictable mental health experience. First, their discomfort: The quickest way to create painful silence or meaningless chatter in 21st-century kids is to push them onto a channel they can’t change. Kids used to a remote control or a default key that allows them to surf through boredom or discomfort are not about to jump into uncomfortable discussions. Interviews that rigidly focus on problems are precisely the wrong way to approach teens who are forced, remanded, or otherwise hauled into seeing an adult. By definition, most adolescents do not want to be with you, so they block the process with the kind of determination only teens can muster. Often, the number one question clinicians ask is “Why were you sent here, what’s your understanding, whose idea was it?” To this question, you will hear versions of “they made me”: the school demanded treatment, the court remanded it, my parents told me “I had to” and other reasons, boiling down to the notion that no one in their right mind would do this willingly, rather than be with friends, or be crazy enough to see a shrink. Essentially the door is already shut Taffel, R. (2005). Breaking through to teens : Psychotherapy for the new adolescence. Retrieved from http://ebookcentral.proquest.com Created from touromain-ebooks on 2020-02-17 19:14:25. Copyright © 2005. Guilford Publications. All rights reserved. 34 BREAKING THROUGH TO TEENS to openness. Thus, many kids, as well as those few kids who enter my lair voluntarily, need to grasp from the get-go that this experience will be different, not the one they’ve geared themselves up for. If, as Freud believed, dreams are the royal road to the unconscious, in today’s world, interests, passions, and pop culture pursuits are the royal road to a child’s inner world. So I say, “OK, we’ll get to the reasons you should or shouldn’t be here later. But, first, what are your interests?” Matt, whom I mentioned earlier, had been an abject failure in school and quite successful being expelled from one institution after another. It was not surprising that his main passion was video games. I asked, “What kind of video games? Tell me the names.” Taken aback by this unexpected non-mental health question, Matt proceeded to describe an assortment of what I knew to be the most violent games on the market today. It was no accident that he could spend 10 hours at a time steeped in a world of killing, vengeance, and gore, because, as I got to know him over time, I saw that Matt’s reservoir of rage was a primary reason he refused to cooperate with any of the schools he’d been sent to. The kind of video games he talked about in his first interview with me was an ordinary clue full of meaningful detail. Talking about this passion right off the bat signaled that our meetings were not going to be a predictable recounting of the same old tired story. In another case, Lila told me that “eye-candy” movies were her only interest. These are the kinds of mindless teenage flicks that are “about absolutely nothing.” Lila enjoyed sitcoms, hours of surfing TV, and “reality” shows. The depth of her shallowness was clear through her unbalanced interests. It came as no surprise that Lila’s issue was maintaining relationships with peers and demanding pursuits. Lila was unable to connect with her own deeper feelings—enough so that even many of her school pals found Lila too boring to hang out with for more than a little while. Pop culture includes movies, TV shows, and, certainly, music. Some time ago I purchased an inexpensive boom box to be one of my therapeutic tools. I invariably ask kids to bring in their CDs. I Taffel, R. (2005). Breaking through to teens : Psychotherapy for the new adolescence. Retrieved from http://ebookcentral.proquest.com Created from touromain-ebooks on 2020-02-17 19:14:25. 2. First Meeting 35 want to hear kids’ favorite musicians and song lyrics. Obviously, one doesn’t usually play music in a first interview, but it’s important to find out what groups a teen likes, what performers matter the most, which lyrics speak to him or her. In one such instance, it was very clear when I asked Ava, “What music do you listen to?” that she prided herself on alternative heavy-metal rock, so obscure it immediately set her apart from the rest of the girls in her suburban school. Ava had been sent to me because she was wildly idiosyncratic and could not fit in. She avidly nurtured this difference by choosing groups almost none of her peers could relate to. Fourteen-year-old Kyle was depressed, chronically “dissed” in school, and developing serious psychosomatic problems. Why? Pretty simple, when you ask ordinary, pop culture questions. Kyle loved (the unthinkable for midadolescent boys)—show tunes! This taste in music, which he had shown during the elementary school years, inaccurately labeled him as gay, a mark he could not shake in the starkly homophobic teen world all around. Kyle loved show tunes, while his peers were into gangsta rap, trash talk, and jock posturing. Copyright © 2005. Guilford Publications. All rights reserved. POP ED FOR CHILD PROFESSIONALS As you listen to kids’ pop culture tastes, it is essential that you actually have something to say. It may seem superficial or phony, but a 21st-century child professional is one who knows a lot about the pop culture world adolescents inhabit. As part of your preparation to effectively connect with kids, I urge you to check out the TV shows most adults reflexively steer clear of, believing (correctly) that they were not made for you. Take in movies you would naturally avoid, and become acquainted with music you may even have moral objections to. As one precocious seventh grader told me years ago, “If you don’t know what any of this is about, it’s impossible to have an intelligent discussion with us.” It is also far less likely that teens will open up to you, an alien representative from a distant cultural galaxy. Taffel, R. (2005). Breaking through to teens : Psychotherapy for the new adolescence. Retrieved from http://ebookcentral.proquest.com Created from touromain-ebooks on 2020-02-17 19:14:25. 36 BREAKING THROUGH TO TEENS Licensing Exam Questions They Forgot to Include 1. Name five “reality” TV shows. 2. Describe the story line of one UPN, WB, or Fox melodrama. 3. Who “tells it like it is”? (a) Ben Stiller, (b) Hillary Duff, (c) Donald Trump, (d) Simon 4. What’s the difference between gangsta rap and hip-hop? 5. What does POS mean? 6. Name the 10 teen movies that came out this past week. 7. Which TV star had her brother’s baby? 8. Who is Usher? 9. What’s on VH1 these days? 10. How many buddies can you IM at once? Copyright © 2005. Guilford Publications. All rights reserved. Friends—More than a TV Show After spending some time on pop culture tastes, I move a bit closer to emotionally charged issues. I ask who his or her friends are. As I wrote in Chapter 1, there has been a profound change in the dynamics that impact on 21st-century teenagers. Over the past two decades, it has become starkly apparent that “the first family” at home often exerts far less gravitational pull on an adolescent (and sometimes on preteens) than “the second family” of the peer group and pop culture. As professionals who attempt to launch the process of change, we need to become aware of this second family. These friendships are often part of the reason a teenager has been sent to you in the first place; they also represent powerful resources for growth (see Chapter 10). Psychological conflict used to be considered the sole province of oppressive, dysfunctional families at home. Today, second-family dysfunction and second-family strength are of major concern, and they must inform our work. Taffel, R. (2005). Breaking through to teens : Psychotherapy for the new adolescence. Retrieved from http://ebookcentral.proquest.com Created from touromain-ebooks on 2020-02-17 19:14:25. 2. First Meeting 37 Copyright © 2005. Guilford Publications. All rights reserved. Draw a “Friends” Sociogram In order to help kids open up about relationships within the second family, I take a piece of paper and do a theme-specific sociogram. In this representation of the peer network, my client is drawn as a circle in the center of the page. I then ask, “Who is your closest friend? Tell me his or her first name. I don’t want to know who he or she is, so just use the first name, please.” I draw a circle placing that person closest to the client’s circle, and then inquire about other friends. They are added on with varying degrees of distance from center stage. The sociogram we create together (in hundreds of cases, only one or two kids have refused) illustrates the basic terrain of the second family in a teen’s everyday life. Constructing this sociogram together lifts the curtain off an adolescent’s world in a way that is easy and unforced. For example, as I wrote down Ava’s different friends, we found ourselves crossing out one after another, or drawing one closer and then moving the same one further away. It quickly became apparent how second-family members continuously ebbed and flowed in their connection to Ava. After doing this sociogram, it was equally clear that Peter had become deeply disconnected from school when his two best friends moved. For different reasons (one boy’s father was reassigned to another part of the country, the other boy’s parents divorced), each suddenly left. It was no accident Peter disappeared into the fantasy world of online video games; he could still stay in touch with these friends in cyberspace, while keeping his distance from the barren world of school. Finding out the players in a teen’s life is a good start. It is also important to inquire more deeply about these friends. An adolescent may be glib or sullenly reluctant to talk about him- or herself and yet be a pop psychologist or ethnographer when it comes to friends. I suggest asking these questions in a specific order having to do with their degree of intimacy—keep in mind the personal nature of peer connections. One enters any family with initial deference to privacy. It is no different with the second family. Taffel, R. (2005). Breaking through to teens : Psychotherapy for the new adolescence. Retrieved from http://ebookcentral.proquest.com Created from touromain-ebooks on 2020-02-17 19:14:25. 38 BREAKING THROUGH TO TEENS Second-Family Matters 1. “What do your friends like to do?” 2. “Who shares your taste?” 3. “Where do you guys like to go out together?” 4. “Who likes to hang out with whom?” 5. “Who do you talk to online?” 6. “Who do you call when there’s a problem?” 7. “Who’s the best listener?” 8. “Who gives the best advice?” 9. “Who are you most worried about?” Copyright © 2005. Guilford Publications. All rights reserved. 10. “No names, but what are the substances of choice in your group?” Approached in this gradual way, areas open up via talk about others. For example, it became clear that Drew had acquaintances. But he had no specific second-family person to talk to when difficulties came up. It was not a surprise that Drew was sent to me for his depressed, withdrawn state when, in fact, his peer group connections were so undeveloped. It was apparent to most other kids that Drew’s friendship circle was sparse; but it was not so clear how much he missed a pal with a good ear. “Real boys” don’t need real support, right? More about that later. Julian, a much more peer-involved 15-year-old, was up every night with different kids in his second family, helping them through their endlessly intense situations. Julian’s problem, unlike Drew’s, was finding it difficult to remove himself from dramatic interactions—the rivalries, jealousies, and conflicts—that his friends discussed over the phone and online till all hours of the morning. It is also possible to get into areas in the first session that are off-limits using the standard initial interview approach. I say this because in almost every first interview, I will ask the following; “No names please, but what are the substances of choice in your Taffel, R. (2005). Breaking through to teens : Psychotherapy for the new adolescence. Retrieved from http://ebookcentral.proquest.com Created from touromain-ebooks on 2020-02-17 19:14:25. 2. First Meeting 39 group?” The ethos of kids in different second families varies greatly, and other kids’ choices are an indirect way for your client to discuss his or her choices. Mariah, a brilliant 16-year-old girl, had been coming and going without any curfew. This question led to an extensive discussion about the use of Ecstasy in her second family. Mariah let me know about her experience with “rolling”—a term to describe Ecstasy—by detailing how many times her friends engaged in this activity during the course of a week (pretty shocking, actually) and how extended use had gotten kids into serious problems that were still under the radar of adults. Likewise, Stanley, a boy who eventually was discovered to have had a serious pot smoking habit, “told” me about it in the first session by describing the smoking rituals of his friends. Having broached the subject this way, Stan gradually let me know about his own daily smoking rituals. Another of my clients, Charlene, a 16-year-old junior, revealed in our initial interview that she was adamantly against smoking pot, but made it clear that her friends were into binge drinking, and had been since the first year of high school. It was no surprise, of course, when Charlene quickly added that she, too, was a heavy drinker, but, “only on the weekends.” This explained her weekend explosions at home, her slow crawl up from Sunday exhaustion to pre-Friday excitement, and her difficulty focusing for any length of time on schoolwork. Copyright © 2005. Guilford Publications. All rights reserved. Leave No Teen Behind: School and Learning By now, after “meeting” the second family, it is possible to bring up touchier issues—school and learning. Many kids who come in for treatment have undiagnosed learning or attentional difficulties. Since this is such a complex area, and may require psychoeducational evaluation, I use the first interview as an initial screening. Teens respond well to direct questions centering on ordinary school experience. Choose from these ordinary-life questions, which help sensitize you to undiagnosed learning issues, attention regulation disorders, and nonverbal learning disabilities: Taffel, R. (2005). Breaking through to teens : Psychotherapy for the new adolescence. Retrieved from http://ebookcentral.proquest.com Created from touromain-ebooks on 2020-02-17 19:14:25. 40 BREAKING THROUGH TO TEENS Learning Issues Quiz 1. What are your favorite subjects? 2. Do you work more when you like a teacher? 3. Do you ever read for pleasure? 4. Do you put things off? 5. Do you work best under a deadline? 6. What does your room look like? 7. Is it easier reading textbooks or the computer? 8. Do you like to sit in the front or the back of the classroom? Do you ask questions in class or fade out? 9. Do you make errors on tests, homework, or reading instructions? 10. Do you edit your writing? Or once done-you’re done? 11. Do you say or do things in class without thinking? 12. Are you uncomfortable in sports or good at them? 13. Are kids mostly nice to you or leave you out? Copyright © 2005. Guilford Publications. All rights reserved. The “First Family” at Home Perhaps 30 minutes into the interview I finally get around to the traditional area of mental health professionals: the client’s family relationships. So far, adolescents have shared with me their interests, passions, day-to-day lives in school, and the players and dramas in the second family. By now one can almost feel pentup demand to talk about the dreaded subject of life at home. You shouldn’t disappoint. Though many kids are philosophically against openness with a child professional, they feel cheated not to have been “shrunk.” Questions about the first family at home and what “landed you here in my office” now almost seem comfortable. This order of inquiry mirrors the way an adolescent views his concerns: second family comes first, first family comes second. Taffel, R. (2005). Breaking through to teens : Psychotherapy for the new adolescence. Retrieved from http://ebookcentral.proquest.com Created from touromain-ebooks on 2020-02-17 19:14:25. 2. First Meeting 41 Copyright © 2005. Guilford Publications. All rights reserved. In this part of the meeting, I ask the following question: “What annoys you most about your parents?” For most clients between the ages of 12 and 17, the word “annoy” is like sodium pentothal. It immediately leads to divulging areas of conflict around the house as well as themes that may become part of your ongoing work together. To this general question one often hears the typical responses. “My parents are crazy.” “We fight about curfew.” “She never lets me stay out as late as my friends.” “They’re always on my back about homework.” “He doesn’t understand,” and so on. But “annoying” is a very well-known commodity to most adolescents, more evocative than therapeutic clichés. Sam said that what annoyed him the most was not the way his father grounded him, or that he could never be sure his dad wouldn’t lash out. It was because of his dad’s gruff tone that Sam felt he could never really open up to him. What annoyed Katy was how her mother spoke to her in a kind of social work, “technique-y,” manner whenever Katy brought up serious, sometimes life-anddeath, issues about friends. For Eddie, annoying meant the times that his mother came home after a hard day’s work and was too tired to even notice how trashed he was. To Paula, it was when her dad looked at her with a hurt expression on his face, and whether that meant the beginning of another depressive cycle for him. After discussions through so many unexpected and even fun topics, the word “annoy” is a door that springs open into the near afterthought of life at home. Customer Service: “How Can I Help You?” Treating kids as sophisticated consumers, and defining your relationship as a service is necessary to move matters forward. Since millennium adolescents are adept at identifying needs yet often inept at meeting them, it makes sense to end a first interview with the question, “How can I help you?” Whether they have been remanded, coerced, or self-referred, most kids actually have some idea about what is missing from their lives. There is no downside Taffel, R. (2005). Breaking through to teens : Psychotherapy for the new adolescence. Retrieved from http://ebookcentral.proquest.com Created from touromain-ebooks on 2020-02-17 19:14:25. Copyright © 2005. Guilford Publications. All rights reserved. 42 BREAKING THROUGH TO TEENS to emphasizing your role as a helper, as long as it is accompanied by some recognition of your limits. “I don’t know whether it will be possible, but I’ll do the best I can.” In her prescient 1972 book, Therapy in the Ghetto: Political Impotence and Personal Integration, Barbara Lerner discovered that most families migrated from clinic to clinic—until they found a person who actually asked, “What do you need?” and then offered a relationship addressing that need. Hans Strupp, in his groundbreaking work Psychotherapy for Better or Worse, found a similar dynamic. People look for a relationship that answers their needs, and end the relationship when it either does or doesn’t deliver. The idea that professionals cannot offer one standard, narrowly defined approach makes sense. Witness the limitations of rigid treatment—from orthodox psychoanalysis to “invariant prescription” to unidimensional PTSD protocols. At the time of Lerner’s and Strupp’s work, the notion that patients could actually understand their own needs was revolutionary, though not surprising. I had seen too many adults precipitously drop out of treatment when therapists tried to force a particular school of thought onto them. Three decades later, the situation with adolescents is similar. Precocious teens often know what they want, but may be more helpless than we realize at effecting positive change. In addition, 21st-century kids from all socioeconomic levels are veteran consumers. Therapy is to kids (just as it is to most everyone else) a product that must ultimately deliver the goods. For example, Lee told me she wanted to stop getting so annoyed at the kids in school. She wanted a best friend with whom she could spend time and confidences. We had gone over her interests, passions, peer network, drawn a map of her second family, described the drugs of choice of her acquaintances, discussed whom she spoke to in times of difficulty, and reviewed school performance and the areas of stress in her first family at home. All this created richness, a poignancy, when Lee said, “If you can help me keep one friend that I can tell things to, maybe I’ll come back.” Ava—who had audacious tastes in music and other pop culture Taffel, R. (2005). Breaking through to teens : Psychotherapy for the new adolescence. Retrieved from http://ebookcentral.proquest.com Created from touromain-ebooks on 2020-02-17 19:14:25. 2. First Meeting 43 Copyright © 2005. Guilford Publications. All rights reserved. Therapists Serve 1. What do you want to change with your friends? 2. What would you like to see different at home? 3. What would you like to change about yourself? 4. Let’s pretend for a minute that I actually have the power to help you with any of this. What would you like to be different? 5. If you were to make three wishes, what would they be? pursuits, was contemptuous of the patronizing tone her parents used “in order to make me feel more like an average American kid.” Ava’s intense self-consciousness in school had a different meaning to me, given the richly detailed picture of her everyday life that emerged in our first meeting. When I asked Ava what she wanted me to help her with, she said, “Make my mom talk normal to me; I already feel different enough in school.” And when Julian said “Maybe you could help me not feel so responsible for my buddies all the time,” his request told a truth not apparent from his icy demeanor. After all, here was a boy who had just described the details of rescue missions on the Internet and phone, who was sacrificing his grades and health in order to be available to kids in even greater trouble. By interview’s end, I knew just how dramatic his second family was—self-cutters, suicide risks, binge drinkers. I got what Julian’s real life was about—far more complicated and dangerous than could be seen by adults’ eyes. What about Confidentiality? The first meeting is coming to its end. A lot has been shared—usually much more than an adolescent may have intended. The issue of confidentiality is a natural one to consider, otherwise a teen may Taffel, R. (2005). Breaking through to teens : Psychotherapy for the new adolescence. Retrieved from http://ebookcentral.proquest.com Created from touromain-ebooks on 2020-02-17 19:14:25. Copyright © 2005. Guilford Publications. All rights reserved. 44 BREAKING THROUGH TO TEENS leave with an unexpected sense of vulnerability, one that often signals a quick exit from the relationship. But the perspective on confidentiality must fit 21st-century teen realities. The usual therapeutic position is one that almost every contemporary high-tech kid is familiar with. By the time they get to us, many clients have been to several agencies and counselors. It’s no news when professionals say, “Anything you tell me is between us. But if I feel there is an immediate danger to yourself or to anyone else, that information will have to be shared.” The problem with this hackneyed statement is not just its predictability. Or that kids play at the edges of being truthful. Or that they tell adults just enough to make it seem as if they’ve been personal, but not nearly enough to help us understand what is actually going on in their lives. The 21st-century context that forces us to reconsider confidentiality is the following: Kids and adults live in different universes. Rather than experiencing adolescent rebellion against enmeshment, many families suffer from lack of traction. Since most teens live with a “wall of silence” around them, adding another wall, this time around the treatment relationship, mirrors a basic problem raising adolescents in today’s world. A helping professional is in danger of creating yet another parallel universe in which adults and children have little chance to get to know each other better. Because the second family is such a powerful force, I now view confidentiality from a different perspective. The statement I casually make at the beginning of the interview (which often goes unheard), and then again toward the end of our time (when it has more meaning), reflects this perspective: “If there’s anything you don’t want me to tell your parents, let me know.” The foreground and background are switched from the message “Except for immediate danger, this space is 100% private,” to “This relationship is going to help you get more of what you want and help your parents become more effective with you.” I continue: “Anything you want kept just with me we’ll talk about. I’ll never say anything to your parents unless we’ve gone over it first.” How do kids react? Most seem at ease with this agreement, figuring they’ve left out truly dangerous material anyway. At this Taffel, R. (2005). Breaking through to teens : Psychotherapy for the new adolescence. Retrieved from http://ebookcentral.proquest.com Created from touromain-ebooks on 2020-02-17 19:14:25. 2. First Meeting 45 Copyright © 2005. Guilford Publications. All rights reserved. point they still feel like they can manipulate the truth pretty much to their liking. Others completely forget what I’ve said the second they leave the room. Others are a bit concerned, but are willing to give it a try, especially since this first meeting has been so unlike what they expected beforehand. A few can’t accept this parameter. In those cases I will discuss my reasons fully, but if it’s still unacceptable I’ll refer the client to a therapist who views confidentiality in a more traditional manner. This is rare—it happens once or twice a year. Kids have so much confidence in their wall of silence, are so sure of their abilities to dissemble (more on that in Chapter 6), that most are not too concerned. In fact, just to show my respect for kids’ ability to keep adults in the dark, I end most first meetings with the following question: “On a scale of 1 to 10, how much of your life have you been honest about with me?” The wry smiles and wide range of scores about their degree of honesty is a good way to begin an authentic relationship with an adolescent. Teens respect an adult who knows that he or she really doesn’t know. Recognizing our limitations is a great way to end first meetings. It is a welcome sign that this may, indeed, be a different kind of relationship than teens, living far off in their distant universe, are used to having with a grown-up. Taffel, R. (2005). Breaking through to teens : Psychotherapy for the new adolescence. Retrieved from http://ebookcentral.proquest.com Created from touromain-ebooks on 2020-02-17 19:14:25.
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