CBT for Youth
Many adolescents begin treatment on a different footing from adults. Rather than choosing to start treatment, adolescents may be referred by someone else for behavior the adolescent sees as justified, appropriate, or a part of their identity rather than something to be changed. Other adolescents may be referred for treatment for behavior or situations they feel hopeless or helpless about, and may therefore enter treatment without a sense that therapy could be helpful or lead to a positive outcome. Given this context, an early focus on treatment engagement is especially important with adolescents.
Given that adolescents may often begin treatment with low engagement, the identification of reasons for engaging in therapy is an important early strategy. Tying treatment to what an adolescent really cares about can greatly increase their buy-in to the therapy process. In contrast, treatment goals are often developed in a way that reflects symptom change, but not necessarily reasons why the adolescent might pursue these goals. When asked about treatment goals, adolescents often say things like, “I will be compliant with medication,” “I will be able to manage my irritability,” or “I will attend school regularly.” But are these really the goals, dreams, or aspirations of this adolescent?
Instead, there is great value in learning what the adolescent really cares about. What makes this client feel like it’s worth getting out of bed in the morning? What lights them up inside – or used to have that effect? What kinds of things do, or did, bring joy or pleasure? Framing treatment as a way to build toward these goals can increase engagement in the therapy process.
There are really three key questions related to helping an adolescent articulate these long-term goals or aspirations.
- What does the teen want?
- What’s getting in the way?
- How can therapy strengthen his or her skills to get there?
When helping the adolescent identify these ambitions or aspirations, look for ways to say, “Yes!” to whatever they identify. Remember that the alternative to this strategy is to basically say, “No.” When we’ve asked an adolescent to name what they care about most, responding by saying, “No, that’s not realistic,” “No, that’s a bad idea,” or another “No” can be off-putting and discouraging – the opposite of what we’re trying to achieve.