Abstract
Adolescents are typically not self-referred, and their developmental stage is characterized by a surge in autonomy seeking, from adults in general and from parents in particular. Quite often, the family therapy context is initially experienced by the adolescent as belonging to the world of adults/parents, and, indeed, in many cases parents view all the family’s difficulties as due to the adolescent’s attitude or misbehavior. The predictable result of this contradictory interpretation of the therapeutic process is a strong challenge to the alliance. In this chapter, we describe strategies for facilitating adolescents’ and parents’ engagement in conjoint treatment, which include (a) “rolling with” initial resistance and validating the adolescent’s subjective experiences, (b) fostering autonomy and individuation, (c) building systemic awareness by reframing the problem systemically, and (d) empowering the parental system. An extended case example describes, through excerpted dialogue, the difficult process of facilitating engagement in a challenging case in which the parents describe their adolescent daughter as “a problem for the family” due to her anxious and excessive use of her smartphone to continuously chat and monitor her social networks. This example illustrates the therapist’s interventions (e.g., dividing the time of the session to combine separate conversations with the adolescent and with the parents without losing the systemic focus) in order to reduce the adolescent’s defensive attitude and the anxious and blaming attitude of the parents. Key to building the alliance was “reframing” the problem by including the bidirectional effect of the parent-adolescent conflict and the couple’s relationship crisis.
Be yourself; everyone else is already taken.
Oscar Wilde
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
Client refuses or is reluctant to respond to the therapist.
- 2.
Client shows indifference about the tasks or process of therapy.
- 3.
Family members validate each other’s point of view.
- 4.
Therapist asks client(s) whether they are willing to do a specific in-session task.
- 5.
Client expresses anxiety nonverbally.
- 6.
Therapist draws attention to clients’ shared values, experiences, needs, or feelings.
- 7.
Client refuses or is reluctant to respond when directly addressed by another family member.
- 8.
Client shows vulnerability (e.g., cries); client varies her emotional tone.
- 9.
Therapist asks one client (or a subgroup of clients) to leave the room in order to see one client alone for a portion of the session.
- 10.
Client leans forward.
- 11.
Therapist expresses empathy for the client’s struggle and normalizes a client’s emotional vulnerability.
- 12.
Therapist expresses interest in the client apart from the therapeutic discussion at hand; therapist remarks on how his/her experiences are similar to the client’s.
- 13.
Therapist draws attention to clients’ shared values, experiences, needs, or feelings.
- 14.
Therapist expresses empathy for the clients’ struggle; therapist expresses confidence, trust, or belief in the clients.
References
Bennett, E. D., Le, K., Lindahl, K., Wharton, S., & Weng Mak, T. (2017). Five out of the box techniques for encouraging teenagers to engage in counseling. Vistas, 2017: http://www.counseling.org/knowledge-center/vistas
Boggs, S. R., Eyberg, S. M., Edwards, D. L., Rayfield, A., Jacobs, J., Bagner, D., et al. (2004). Outcomes of parent-child interaction therapy: A comparison of treatment completers and study dropouts one to three years later. Child and Family Behavior Therapy, 26, 11–22.
Bolton Oetzel, K. B., & Scherer, D. G. (2003). Therapeutic engagement with adolescents in psychotherapy. Psychotherapy: Theory, Research, Practice, and Training, 40, 215–225.
Bowen, M. (1978). Family therapy in clinical practice. New York, NY: Jason Aronson.
Daly, K. D., & Mallinckrodt, B. (2009). Experienced therapists’ approach to psychotherapy for adults with attachment avoidance or attachment anxiety. Journal of Counseling Psychology, 56, 549–563.
Diamond, G., Russon, J., & Levy, S. (2016). Attachment-Based Family Therapy: A review of the empirical support. Family Process, 55, 595–610.
Diamond, G. M., Diamond, G. S., & Liddle, H. A. (2000). The therapist–parent alliance in family-based therapy for adolescents. JCLP/In Session: Psychotherapy in Practice, 56, 1037–1050.
Diamond, G. M., Liddle, H. A., Hogue, A., & Dakof, G. A. (1999). Alliance building interventions with adolescents in family therapy: A process study. Psychotherapy, 36, 355–368.
Eyrich-Garg, K. M. (2008). Strategies for engaging adolescent girls at an emergency shelter in a therapeutic relationship: Recommendations from the girls themselves. Journal of Social Work Practice, 22, 375–388.
Feder, M. M., & Diamond, G. M. (2016). Parent-therapist alliance and parent attachment promoting behaviour in attachment-based family therapy for suicidal and depressed adolescents. Journal of Family Therapy, 38, 82–101.
Frankel, Z., & Levitt, H. (2009). Clients’ experiences of disengaged moments in psychotherapy: A grounded theory analysis. Journal of Contemporary Psychotherapy, 39, 171–186.
Friedlander, M. L., Escudero, V., & Heatherington, L. (2006). Therapeutic alliances with couples and families: An empirically-informed guide to practice. Washington, DC: American Psychological Association.
Friedlander, M. L., Heatherington, L., & Marrs, A. (2000). Responding to blame in family therapy: A narrative/constructionist perspective. American Journal of Family Therapy, 28, 133–146.
Friedlander, M. L., Lambert, J. E., & Muñiz de la Peña, C. (2008). A step toward disentangling the alliance/improvement cycle in family therapy. Journal of Counseling Psychology, 55, 118–124.
Heatherington, L., Escudero, V., & Friedlander, M. L. (in press). Where systems theory and alliance meet: Relationship and technique in family therapy. In O. Tishby & H. Wiseman (Eds.), Developing the therapeutic relationship: Integrating case studies, research and practice. Washington, DC: American Psychological Association.
Heatherington, L., & Friedlander, M. L. (1990). Couple and family psychotherapy alliance scales: Empirical considerations. Journal of Marital and Family Therapy, 16, 299–306.
Higham, J., Friedlander, M. L., Escudero, V., & Diamond, G. M. (2012). Engaging reluctant adolescents in family therapy: An exploratory study of in-session processes. Journal of Family Therapy, 34, 24–52.
Hogue, A., Dauber, S., Stambaugh, L. F., Cecero, J. J., & Liddle, H. A. (2006). Early therapeutic alliance and treatment outcome in individual and family therapy for adolescent behavior problems. Journal of Consulting and Clinical Psychology, 74, 121–129.
https://www.cdc.gov/violenceprevention/pdf/suicide-datasheet-a.pdf.
Jones, V. F. (1980). Adolescents with behavior problems: Strategies for teaching, counseling, and parent involvement. Boston: Allyn & Bacon.
Karver, M., Shirk, S., Handelsman, J. B., & Fields, S. (2008). Relationship process in youth psychotherapy: Measuring alliance, alliance-building behaviors, and client involvement. Journal of Emotional and Behavioral Disorders, 16, 15–28.
Kessler, R. C., Amminger, G. P., Aguilar-Gaxiola, S., Alonso, J., Lee, S., & Ustun, T. B. (2007). Age of onset of mental disorders: A review of recent literature. Current Opinion in Psychiatry, 20, 359–364.
Madsen, W. C. (2007). Collaborative therapy with multi-stressed families. New York: Guilford Press.
Muñiz de la Peña, C., Friedlander, M. L., & Escudero, V. (2009). Frequency, severity, and evolution of split family alliances: How observable are they? Psychotherapy Research, 19, 133–142.
Muñiz de la Peña, C., Friedlander, M. L., Escudero, V., & Heatherington, L. (2012). How do therapists ally with adolescents in family therapy? An examination of relational control communication in early sessions. Journal of Counseling Psychology, 59, 339–351.
Niwa, M., Lee, R. S., Tanaka, T., Okada, K., Kano, S. I., & Sawa, A. (2016). A critical period of vulnerability to adolescent stress: Epigenetic mediators in mesocortical dopaminergic neurons. Human Molecular Genetics, 25, 1370–1381.
Pinsof, W. B., & Catherall, D. R. (1986). The integrative psychotherapy alliance: Family, couple and individual therapy scales. Journal of Marital and Family Therapy, 12, 137–151.
Raviv, A., Raviv, A., Vago-Gefen, I., & Fink, A. S. (2009). The personal service gap: Factors affecting adolescents’ willingness to seek help. Journal of Adolescence, 32, 483–499.
Robbins, M. S., Alexander, J. F., Newell, R. M., & Turner, C. W. (1996). The immediate effect of reframing on client attitude in family therapy. Journal of Family Psychology, 10, 28–34.
Rogers, L. E., & Escudero, V. (2004). Relational communication: An interactional perspective to the study of process and form. London: Lawrence Erlbaum Associates.
Rohrbaugh, M. J. (2014). Old wine in new bottles: Decanting systemic family process research in the era of evidence-based practice. Family Process, 53, 434–444.
Santrock, J. W. (2015). Life-span development (15th ed.). New York: McGraw-Hill Education.
Shelef, K., Diamond, G. M., Diamond, G. S., & Liddle, H. A. (2005). Adolescent and parent alliance and treatment outcome in multidimensional family therapy. Journal of Consulting and Clinical Psychology, 73, 689–698.
Shirk, S. R., & Karver, M. (2003). Prediction of treatment outcome from relationship variables in child and adolescent therapy: A meta-analytic review. Journal of Consulting and Clinical Psychology, 71, 452–464.
Sotero, L., Major, S., Escudero, V., & Relvas, A. P. (2016). The therapeutic alliance with involuntary clients: How does it work? Journal of Family Therapy, 38, 36–58.
Thompson, S., Bender, K., Lantry, J., & Flynn, P. (2007). Treatment engagement: Building therapeutic alliance in home-based treatment with adolescents and their families. Contemporary Family Therapy, 29, 39–55.
Utley, A., & Garza, Y. (2011). The therapeutic use of journaling with adolescents. Journal of Creativity in Mental Health, 6, 29–41.
Veach, L. J., & Gladding, S. T. (2007). Using creative group techniques in high schools. Journal for Specialists in Group Work, 32, 71–81.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing AG
About this chapter
Cite this chapter
Escudero, V., Friedlander, M.L. (2017). Engaging Reluctant Adolescents and Their Parents. In: Therapeutic Alliances with Families. Focused Issues in Family Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-59369-2_3
Download citation
DOI: https://doi.org/10.1007/978-3-319-59369-2_3
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-59368-5
Online ISBN: 978-3-319-59369-2
eBook Packages: Behavioral Science and PsychologyBehavioral Science and Psychology (R0)