Adolescence, and How They Have the Potential

¶ … Adolescence, and How They Have the Potential to Impact Your Work as an Adolescent and Family Counsellor

Issue Usually Adolescents Face

Adolescence is a somewhat universal period of transition where females experience physical, emotional, psychological, and social changes. Cultures vary as to how they define and deal with the "growing up" period. Only the biological changes of puberty are consistent across cultures. Secondary sexual characteristics, such as breasts, may begin as early as 8 or 9 and continue to develop until about age 14. Menarche begins around this same time with the average age in the U.S. being 12.5 years. Behaviorally, these rapid changes often lead to comparison with peers, self-consciousness, and significant concern over one's physical appearance (Greene, 2005).

Orvaschel, Beeferman, and Kabacoff (1997) found that self-esteem tends to decrease with advancing age, at least through late adolescence. Most likely this is related to changing appearances, increased self-consciousness, and increased peer scrutiny in adolescent girls and boys. While it is unknown whether poor self-esteem is a precursor to depression and other mood disorders, or vice versa, a relationship between the two exists. This is important because self-esteem can act as a protective factor against depression and suicidality. Good self-esteem also has effects on intimacy in later adult relationships. In this I will describe the problem I faced during my adolescence and how these problems will impact my practice as a counsellor while dealing with the adolescents.

How I will manage the issue as a Counsellor

Communication with Adolescents

Communication is said to lie "at the heart of our relationships" because "we do not relate and then talk, but we relate in talk" (Rogers & Escudero, 2004, p 3.). By extension, communication "lies at the heart of" the therapeutic relationship, where therapist and client relate "in talk." This view implies that, while relationships contextualize and shape the way people communicate, relationships are also constructed and influenced by communication processes (Rogers & Escudero, 2004).Therefore, in studying the therapeutic alliance, it is important to consider how therapist and clients communicate with one another.

Engaging adolescents in beneficial communication is often difficult because of the circumstances under which they attend therapy sessions. Adolescents are considered "therapy hostages" (Friedlander et al., 2006) when they tend not to be part of the decision to seek therapy; often, adolescents tend to be referred or mandated by the parents or another authority figure (Shelef, 2005; Rubenstein, 2003). In Bergand Miller's (1992) words, adolescents tend to be "visitors" to the therapeutic process because of their low motivational level and because they tend to be criticized by other family members, who blame them for the family's problems (Friedlander., 2006;Sharry, 2004).

Therapists may engage in cajoling and haranguing therapy "visitors" to participate, which can only worsen the situation (Sharry, 2004). However, it seems more useful to assume that everyone who attends the session is motivated to achieve something in therapy, although a client's personal goals may differ from and conflict with the goals agreed upon at the onset of therapy (Sharry, 2004).

Indeed, adolescents often have goals that differ from those of their parents, which makes alliance formation with this population more challenging but, ironically, more critical to treatment outcome (Liddle, 1995). For this reason, some authors recommend that, for treatment to be successful, therapists should incorporate the adolescent's concerns and desires into the treatment process, providing them with a sense of control (Diamond, Hogue, Liddle, & Dakof, 1999; Sharry, 2004). According to Liddle (1995), it is only when adolescents trust the therapist and feel connected that treatment can be successful. Communication with adolescents must, therefore, be handled in a way that helps adolescents feel included, respected, and cared for.

In developing a positive relationship with adolescents, particularly in the context of family therapy, one must consider the barriers to productive communication that have to do with the typical characteristics of adolescence (Diamond., 2000;Sharry, 2004). That is, developmental differences can make it difficult for therapists to communicate simultaneously with adolescents and parents (Diamond et al., 2000).Along with less ability to think abstractly than parents and communicate verbally, adolescents struggle with issues like independence from parents, identity, sexuality, and so forth (Sharry, 2004). As they begin to seek more autonomy, adolescents become more apt to confront their parents and, by extension, any adult in an authoritative role, including therapists (Diamond et al., 2000). Adolescents also tend to be more private, self-conscious, and awkward, which challenges the therapist's desire to get close to them and elicit their worldviews (Sharry, 2004). In general, adolescents often strive for control in an environment where they tend to have little say, posing roadblocks for building positive therapeutic relationships.

When considering the developmental characteristics of adolescents, particularly in the arduous context of family therapy, the therapist may tailor interventions to facilitate emotional safety, which is necessary for adolescents to open up in session and become involved. There are a number of studies that suggest that therapist effective interventions focus on the adolescent and aim at including his or her voice in the therapy process. For example, Diamond et al. (1999) explored therapist behaviours associated with improving initially poor therapist-adolescent alliances in the context of Multidimensional Family Therapy (MDFT). A list of therapist behaviours was generated from the MDFT model and other research in the area and was refined with the help of experts. Once the list was refined, five improved and five unimproved alliance cases of primarily African-American, male, adolescent substance abusers and their families were observed in their first three sessions. Observations showed that, by session 3, therapists were attending to the adolescent's experience, formulating personally meaningful goals, and acting as the adolescent's ally more extensively in the improved alliance cases than in the unimproved alliance cases (Diamond et al.,1999). These results suggest that an initially poor alliance can improve by listening8carefully to adolescents, giving them a voice and promoting autonomy, (Diamond etal., 1999).

In a similar study, Hogue, Dauber, Samuol is, and Liddle (2006) found that adolescent-centered interventions were effective. These interactions included meeting alone with the adolescent on a regular basis, working to establish and maintain a strong alliance, focusing on the adolescent's problems, building individual social skills, and addressing other developmental tasks. Notably, interventions of this sort uniquely predicted improvement in some cases and moderated the impact of family interventions on others.

In a review of the clinical and empirical literature on therapy with adolescents, Bolton Oetzel and Scherer (2003) suggested that adolescent autonomy development has important implications for alliance formation. Theoretically, healthy autonomy is facilitated when parents and therapist grant adolescents increasing psychological freedom, remain emotionally available, and expect and enforce responsible behaviour (Bolton Oetzel & Scherer, 2003). Research suggests that adolescents who experience the enhancement of personal autonomy in therapy show greater satisfaction with treatment at termination (Bolton Oetzel & Scherer, 2003). Indeed, Bolton Oetzel and Scherer's results showed that adolescents tended to talk more about the therapy or the therapeutic relationship and asked the therapist for advice more frequently when the therapists made certain kinds of interventions. These interventions included presenting themselves as an ally, encouraging the adolescent to find his or her own solutions, facilitating the discussion of possible negative feelings about the therapy and the therapeutic relationship, taking responsibility for confidentiality, and providing reasonable structure for the session (Bolton Oetzel & Scherer, 2003). Along with these findings, it is reasonable to suggest that therapists may develop better alliances with reluctant adolescents to the extent that they can join with them and engage them cooperatively early on in the therapy process.

Relational Control Communication

In this essay the researcher examined how communicate with adolescent clients in the context of family therapy and whether specific communication patterns reflect strong and weak therapeutic alliances. The communication variable of interest is relational control. Initially introduced in the 1960s, relational (or interpersonal) control has been studied in the context of individual as well as couple and family therapy (Ericson & Rogers, 1973; Friedlander, Wildman & Heatherington, 1992;Friedlander & Heatherington, 1989; Heatherington & Friedlander, 1990; Lichtenberg, Wettersten, Mull, Moberly, Merkley, & Corey, 1998; Raymond, Friedlander, Heatherington, Ellis, & Sargent, 1993; Rogers & Escudero, 2004). Relational control is based on Bateson's (1935) theory of culture contact and schizogenesis which addresses cultural group interactional patterns which reflect differentiation or reciprocity. Applied to social relationships, relational control refers to how people use verbal and nonverbal language in order to influence others, reflecting the implicit hierarchical and relational structure of messages people exchange with one another (Rogers & Escudero, 2004). The assumption is that relationships and communication are interconnected, appearing simultaneously and influencing each other reciprocally, and that communication or relationship patterns lie between individuals rather than within individuals (Rogers & Escudero, 2004). According to Ericson and Rogers (1973), relational control is contextual and has more to do with the process of communication than with the content of messages.

The focus of attention in relational control communication is the contiguity of individual messages rather than the individual messages themselves (Rogers & 10 Escudero, 2004). More specifically, the unit of analysis is the communication interchange, the speech turn at the dyadic level or "reactions of individuals to the reactions of other individuals" (Rogers & Escudero, 2004, p. 12). Based on Bateson's (1935) original classification, three interactional patterns can be identified: complementary, symmetrical, and transitory (Rogers & Escudero, 2004). In complementary interactions, the definition of the relationship offered by one participant is accepted by the other and is reflected in communication exchanges such as closed question-answer or command-compliance (Friedlander et al., 1991). In contrast, competitive-symmetrical exchanges show participants' discrepant views of who is in control in a social relationship, evidenced by sequences of challenges and counter challenges, such as when one person changes the topic of conversation and the other person does not follow along, or when one person asks a question and there is no response (Ericson & Rogers, 1973). Transitory exchanges, the third transactional style, are neutral, non-control-defining communication patterns where, for example, a speaker responds by extending the previous speaker's topic.

A number of psychotherapy studies using these concepts have found that, overall, the predominant relational control pattern shown by therapists in individual and family therapy tends to be complementarily (Friedlander et al., 1991; Friedlander & Heatherington, 1989; Raymond et al., 1993). In other words, therapists tend to take a dominant ("one-up" or ?) position with clients who, in turn, tend to assume a submissive ("one-down" or ?) position (Friedlander & Hetherington, 1990). In contrast, relational control patterns characterized by question-answer and symmetrical exchanges (i.e., interruptions, no supportive responses, etc.) are more frequently observed in the initial sessions of clients who subsequently drop out of treatment (Beyebach & Escudero, 1997; Heatherington & Friedlander, 2004). Eyebath and11Escudero (1997), for example, compared the relational communication patterns of 16 dropout versus 16 continuation cases of solution-focused therapy. More conflictive therapeutic interactions and more domineering behaviours were observed in the dropout group than in the continuation group. Moreover, clients in the dropout group were more likely to adopt a one-up position and their therapists were less likely to respond with a one-down complementary message. However, clients in this study were largely adults seen in individual therapy, not adolescents in family therapy.

There is some evidence that relational control patterns reflect differences in therapeutic orientations. Friedlander et al. (1991) compared six family therapy interviews by expert therapists, three from the structural approach and three from the Milan systemic approach. Results supported theoretically predictable differences in relational control patterns between the two approaches consistent with the therapist distinct styles. Specifically, the structural sessions were characterized by more overtcontrollingness and competition whereas the systemic sessions evidenced greater complementarity (Friedlander et al., 1991). Relatedly, Heatherington (1990) compared a number of family and individual therapies with respect to four different indicators of domineeringness. Results revealed substantive differences between family therapy approaches themselves and illustrated that, in contrast with popular beliefs, some individual therapy approaches are more controlling than some family approaches. It was argued that differences in therapist controllingness arise from the theory of change rather than from the nature of the client system (i.e., family vs. individual)(Heatherington, 1990).