Assessing Teenagers: Part 1
Assessing Teenagers (part 1): how do you get to know them when they don’t know themselves?
By Elizabeth Escobar & Kathryn Staron
“Parents Just Don’t Understand”, famously written by the actor and former rapper Will Smith, captures the mentality of our youth today. When assessing teenagers we want them to feel heard and understood.
Working with adolescents is both rewarding and challenging. Teenagers often test the helping professional by refusing to engage, changing the subject or by being provocative.
Establishing rapport with a teen can be difficult, but here are a few pointers to assist with developing strengths in working with this age group. Due to the fact that maturity levels vary, not only in their chronological age, but also from teen to teen, it is important to have many tools in your toolbox.
The one thing that is universally needed when working with teenagers is genuineness. Teenagers often do not “trust” adults because they see us as trying to change them. They often feel criticized, judged and shamed, even when the therapist is silent. While boundaries are important, as in every therapeutic encounter, it is imperative that the client sees the therapist as “having their back” and we share this sentiment with the young client early on.
Encourage them to listen to their parents’ perspective.
“Paul, I am going to start with your parents and I will ask them lots of questions today. I would like you to sit here and just listen for now. If they say anything you don’t like, or you don’t agree with, hold on to your thoughts. The good news is that you get to hear everything they are saying. After I am finished asking them questions, I will ask them to wait outside and they won’t get to hear anything you are saying! Is that a deal?”
The majority of teenagers we have worked with have agreed to this. This cuts down on disruptions and allows the therapist to be aware of body language when the parents make statements that the teen takes issue with. When the adults leave the room, the best opening lines are, “So? What did you agree or disagree with?” and then the teens will tell you. They love to tell you how their parents have it all wrong, or, that they agree with the parents, but then add their version of why a particular incident occurred. In short, it is a great way to establish a rapport because the client knows you want to give him/her “equal air time”.
Parents sometimes question this approach. They often feel entitled to all of the information. Educating the parents on the importance of confidentiality (and its limitations) in its ethical practice, as well as its importance in establishing rapport, often helps alleviate the anxiety the parents may experience.
Gathering valid information
Despite numerous attempts at prevention and early intervention, unfortunately experimental drug use in adolescence is not the exception to the rule. When assessing a teen for drug use, framing the questions is imperative. Rather than allowing the teen to answer with a “yes” or “no” response (which provides limited information) you should consider asking the teen, “When was the first time that you used marijuana?” “When was the first time you used prescription pain medication?”
By wording the questions this way, the clinician removes the likelihood that the teen will lie about their experimentation in their response. “How awful!” you may say, “to assume that teenagers have used multiple drugs or that teenagers will lie.” Rest assured that teenagers will quickly correct the clinician if they are making false assumptions. “I have never used opiates!” they will say with great enthusiasm. Note that teenagers, like others, may lie about the quantity and frequency of their use. Experience has shown that when teenagers have been admitted to treatment centres, they often say to the assessing clinician, “I’m sorry I lied to you in the interview….I really drank every weekend and not every other.” We would always reassure them that getting honest with themselves and others is a process and we are just happy they are in the program.
It is best to not take notes when working with teenagers as they see it as a huge barrier and as a trust issue. This is often difficult for therapists because we need to keep track of details. The best approach is to let the client know that we will need to take a few notes (the what, when, how often and why) in order to keep the important details at the forefront of our mind. Allowing the client to read our notes before the end of session often eases their mind.
Understand their point of view
It is important to understand, when working with teenagers (or adults), is the defence of denial. When working with substance users it is important to help them understand the negative aspects of their use. It is the clinician’s natural tendencies to convince the client that they do, in fact, have a problem. This practice is not as effective as “rolling with the resistance” that is clearly defined in Motivational Interviewing. Remember, one goal in the assessment is to gather valid information, but also to allow the teen the room to verbalise their understanding of the situation. If they know that the clinician has their best interest in mind, the end goal, level of care recommendation, will be met with a more genuine and thoughtful response.
Allowing the client to identify the “positives” of their use, or “why they use”, is an important starting place. Then we encourage the client to take a genuine look at any negatives of their use. “None” they may say. “I’m only here because my parents think I have a problem!” This common response can easily be disputed in a loving way by asking, “How do you feel about having to come and sit with me? Is it bothersome to answer all of these questions?” The most likely response is “Yes, this is pointless, I don’t need to be here.” With a warm smile we may respond with, “Well, because of your drug use you have to come sit here with me. That sounds like this may be a negative! Well, now we are on to something.”