Numerous studies have looked at the relationship between client and therapist. This therapeutic alliance is a fundamental concept that constitutes core learning for all clinicians. Generally, the studies have taken the perspective of the alliance from the therapist's point of view. Very little current research has been related to qualities sought by adolescents in those from whom they might seek help.
Oetzel and Scherer state that engaging adolescents in therapy calls for a good understanding of adolescent development.1 A major difference between the adolescent and adult stages lies in adolescents’ cognitive ability to understand their problems and work with various change strategies. The authors note that it is important to offer therapeutic support, not advice, in recognition of the need to develop autonomy among adolescents. They encourage more research to determine how adolescents view the process of engagement in therapy and to find methods for overcoming barriers to effective engagement.
Respect, time, and openness
A recent response to these questions can be found in a qualitative study by Martin and colleagues.2 This study looked at a non-clinical population, assuming that similar findings would apply to adolescents with behavioral health problems. The domains that the study evaluated in terms of relationships between adolescents and adults were respect, time shared, openness, role characteristics, recognition, guidance, identification, trust, freedom, like/dislike, responsibility, and familiarity. The study participants believed that the first three items mentioned on that list were the most important areas surrounding a relationship with an adult.
The participants reported that they felt respected when they were invited into a conversation and when they felt that the adult spoke with them versus down to them. Having a sense that the adult liked to be with and around adolescents was important in terms of time shared. Openness was exemplified by an adult being able to listen in a nonjudgmental manner and also recognizing that the adolescent has a valid new idea or approach.
In addition, the study found that adolescents like adults to view them as mature, capable, and aware. They added that they want adults to support them empathetically yet also to guide them.
A second study from Timlin-Scalera and colleagues investigated specific barriers to formal help-seeking by white adolescent males in an affluent community.3 The researchers reported that issues around confidentiality, unfamiliarity with the helping professional's role, a reluctance to burden others, and the belief that males are weak if they seek help constituted the predominant barriers in seeking help from an addiction or mental health treatment professional.
Practitioners need to take seriously the findings of both of these studies. Perhaps it is time to look at how we present ourselves in our day-to-day practice. How might we show our adolescent clients the respect they are asking for from their helping professional? Do we see “adolescents with addiction and mental health problems” or do we see them simply as “addicts”? Can we support the adolescent client who presents for treatment or do we simply lay out a standard treatment plan and fill in the blanks with the person's name? Do we engage our adolescents with open-ended questions or do we simply have them fill out an inventory and move on to completing a standard treatment plan?
We constantly encourage all of our clients to work one day at a time and to have a plan for their day. What plan do we as practitioners have to respond to the request of a growing population of people seeking not only our professional expertise but also the presence of a caring, empathetic adult who enjoys the challenges of dealing with adolescent clients?
Steven Durkee, LPCC, CADC, is a clinician with Summit Behavioral Health Group, LLC, in Crestview Hills, Kentucky, and is a member of the Adolescent Specialty Committee of NAADAC, The Association for Addiction Professionals. His e-mail address is
- Oetzel KB, Scherer DG. Therapeutic engagement with adolescents in psychotherapy. Psychotherapy Theory Res Prac Train 2003; 40:215–25.
- Martin J, Romas M, Medford M, et al. Adult helping qualities preferred by adolescents. Psychotherapy Theory Res Prac Train 2006; 41:127–40.
- Timlin-Scalera RM, Ponterotto JG, Blumberg FC, et al. A grounded theory study of help-seeking behaviors among white male high school students. Psychotherapy Theory Res Prac Train 2003; 50:339–50.