One of the most gut-wrenching decisions I ever made in my private practice was to stop working with adolescents.
I loved seeing teens. I loved their energy, enthusiasm, and full blown emotions, thoughts, and opinions.
I completed one of my internships at a high school and thoroughly enjoyed offering individual art therapy and leading classes about grief and identity.
When I opened my private practice, it seemed like a natural continuation to see teens.
However, over the course of a year, I realized that working with teens in a solo private practice was a completely different endeavor than working with teens in a high school, group setting, or organization.
All of the challenges that come with working with teens were magnified given that it was just me - I had no group, system, or community to rely on.
It was very difficult for me to look these realities in the eye and admit that I needed to stop working with teens in my private practice. Here’s what led me to that decision:
1. Family therapy is needed
I would make wonderful progress on individual work with a teen, but there were ALWAYS things that needed to be addressed in the family system. I originally thought I could see the teen for individual counseling and then bring the family in for family counseling as needed.
This did not work as well as I thought it would. Due to the strong relationship I developed with the teen through individual therapy, the dual-relationship of then being their family therapist was challenging. I would know things about the teen that I couldn’t disclose to the parents that were impacting the situation. I also couldn’t force the teen to say these things. Furthermore, many teens became concerned of what would or wouldn’t come up in family therapy.
I realized that the best structure would be if there was another therapist in-house that could provide family therapy. This would enable the therapist and I to easily brainstorm and work together outside of session.
However, as a solo private practice, I didn’t have that.
2. My skill set is in individual therapy
I am a far better individual therapist than I am a family therapist. My unique ways of communicating and relating are far more beneficial in an individual session than group therapy.
Furthermore, family therapy takes a different set of skills. I know I can learn and develop as a therapist, but I also find groups to be incredibly energy draining (as an autistic individual, I am aware of my energetic pulls and groups is one of them). I realized I was not particularly skilled as a family therapist, nor did I want to make the investment to get better at something that I find exhausting.
3. Teens do not have autonomy over their lives.
Teens are not legally independent and thus typically live within the rules and environments of others.
They cannot immediately choose to change where they live, go to school, who they are around on a daily basis, the rules of their environment, and much more. In individual therapy with adults, we often work on how to make changes that honor their needs. Many teens are simply not able to make those changes yet.
4. Parents have many expectations of therapy
Parents frequently have many expectations of what will happen in therapy and what progress will look like. I always did my best to discuss this with parents ahead of time. I would explain that progress in therapy is typically internal first - meaning a parent will not not necessarily see external or behavioral changes, but that the teen will begin to feel better internally.
Parents always understood and agreed with this. However, after months of therapy, they would inevitably become frustrated by the lack of external change.
I’d be told things like, “Their grades still haven’t improved” or “She still sits in her room all day” or “He still won’t come to our family BBQs.”
It was difficult to navigate, especially considering it was parents who were paying for their teens therapy and wanted to see a return on their investment.
5. It’s a lot of extra work outside of the therapy room
Given that teens are minors, I had to do a lot of legwork outside of the therapy room to coordinate schedules, treatment length, frequency of meetings, updates, and more. With adults, I could handle this directly in a session.
This is another area where I acknowledge it would be easier within a group practice where there is more administrative support.
Furthermore, there are also extra unforeseen meetings, such as when I need to inform parents on a matter (such as self harm), make a mandated report, speak with my supervisor about mandatory reporting, or have a check-in meeting with parents.
6. Confidentiality get messy
It was my experience that adolescents were typically willing to open up and share about the painful topics in their lives, such as self-harm, abuse, and more. However, my teens were not necessarily ready to share those things with their parents. Given confidentiality and mandatory reporting laws, I would need to report those things.
It was a very tricky line to walk with teens. There were times that I knew a teen wanted to share something, but they were concerned I would have to tell their parents. There were other times teens were upset when I told them I would need to inform their parents (even though they had already been informed about the limits of confidentiality).
7. Money can makes things more complicated
When a parent pays for therapy for their teen, it can come with unspoken expectations. One teen reported that while she and her mom were arguing about buying a dress for an upcoming dance, the mom chided, “Do you know how much money I’m spending on you in therapy?!” Other parents would place pressure on their teens to “work harder” to get better, citing that they were doing their part by paying for therapy and teens needed to do their part.
Another complication of having a parent pay for therapy is that a teen may not be as invested in the therapy process. When someone has to pay for therapy out of their own pocket, they are more likely to show up and commit to the process of therapy. I would occasionally have teens who could drive on their own, but would “forget” to come to therapy or choose to hang out with their friends if an opportunity arose. Therapy is most effective when a person fully wants to be there.
8. Scheduling is more difficult
In order to find a meeting time for a teen client, it has to work for my schedule, the teen’s schedule, and whoever is transporting the teen. There is also the constraint of school hours. These factors make finding a weekly timespot extra challenging.
9. It’s a lot to carry emotionally on one’s own.
All of the aforementioned factors add to the emotional weight and stress of working with teens. This is where the support of understanding coworkers or a support team would be beneficial.
As a solo private practice, I do not have any of that.
Honoring my Needs
Given all of the above, I knew it was best for me to no longer work with teen clients. My needs and limitations were clear, and I decided to honor those.
That does not mean it was easy. I went through my own grieving process in concluding with my teen clients.
It’s been over a year now since I did that, and I can say unequivocally that it was absolutely the right decision for me. I am grateful I took the time to look at what wasn’t feeling like a good fit for my practice and make the necessary changes.
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